经阴道手术治疗子宫瘢痕妊娠的经验体会  

The experience of transvaginal surgery for cesarean scar pregnancy

作　　者：吕秀清[1] 袁文娟[1] 李婧[1] 薛燕 范俊[1] LüXiuqing;Yuan Wenjuan;Li Jing(Department of Gynecology,Qingdao Municipal Hospital Affiliated Medical College of Qingdao University,Qingdao 266071)

机构地区：[1]青岛大学医学院附属青岛市市立医院妇科,青岛266071

出　　处：《现代妇产科进展》2018年第11期821-824,共4页Progress in Obstetrics and Gynecology

摘　　要：目的:总结分析经阴道手术治疗子宫瘢痕妊娠(CSP)的经验,以降低经阴道治疗CSP失败风险。方法:回顾分析2015年4月至2018年4月在青岛大学医学院附属青岛市市立医院妇科行经阴道手术切除瘢痕妊娠病灶的25例CSP患者的临床资料。根据子宫瘢痕距宫颈外口的距离将手术成功病例分为≤4.5cm组和>4.5cm组,比较两组的出血量及手术时间。结果:25例CSP患者中,4例失败,其中有3例中转腹腔镜,其原因分别为多次剖宫产导致盆腔粘连严重、子宫瘢痕妊娠至宫颈外口距离过长、Ⅲ型子宫瘢痕妊娠病灶过大; 1例因病灶周围血流信号丰富,出血过多,保守治疗失败后行子宫动脉栓塞术(UAE)。21例成功案例中,>4.5cm组较≤4.5cm组的手术时间长,出血量多,差异有统计学意义(P<0.05)。结论:盆腔粘连较重尤其为二次剖宫产及其以上者、子宫瘢痕至宫颈外口距离过长(>4.5cm)、Ⅲ型子宫瘢痕妊娠病灶过大、病灶周围血流信号丰富者慎行经阴手术。Objective:To decrease the failure risk of transvaginal surgery for cesarean scar pregnancy(CSP).Methods:25 CSP patients who received transvaginal surgical treatments were analyzed retrospectively.These patients were admitted in Gynecology of Qingdao Municipal Hospital Affiliated to Qingdao University between Apr.2015 and Apr.2018.21 successful cases were divided into two groups by the distance from the cesarean scar to the external cervical orifice(d).Group 1 was d≤4.5cm and group 2 was d>4.5cm.Then the operation time and intraoperative blood loss were compared between the two groups.Results:There were 4 cases failed among 25 cases.Transvaginal surgery was changed into laparoscopic surgery in 3 cases for serious pelvic adhesions,long distance from the cesarean scar to the external cervical orifice and oversize lesions of III type CSP respectively,and 1 case received uterine artery embolization(UAE)for excessive bleeding caused by rich blood supply around the lesion.The operation time and intraoperative blood loss in group 2(d>4.5cm)were respectively significantly more than in group 1(d≤4.5cm)(P<0.05).Conclusions:Transvaginal surgery should not be done in CSP patients who have serious pelvic adhesions,particularly received cesarean section for twice or more,long distance from the cesarean scar to the external cervical orifice(d>4.5 cm),oversize lesions if they are III CSP patients or rich blood supply around the lesion.

关 键 词：剖宫产瘢痕妊娠 阴道式 经验 

分 类 号：R714.2[医药卫生—妇产科学]