举宫杯在Ⅱ、Ⅲ型剖宫产瘢痕妊娠患者宫腹腔镜手术中的应用  

Application of uterine cup during hysteroscopy and laparoscopy in patients with type I or II Cesarean scarpregnancy

作　　者：汤伟伟[1] 李杏杏[1] 周文娟[1] 成臣 沈晓婷[1] 万贵平[1] 朱利[1] TANG Weiwei;LI Xingxing;ZHOU Wenjuan;CHENG Chen;SHEN Xiaoting;WANGuiping;ZHU Li(Department of Obstetrics and Gynecology,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210028,CHINA)

机构地区：[1]南京中医药大学附属中西医结合医院(江苏省中医药研究院)妇产科,江苏210028

出　　处：《江苏医药》2025年第1期5-7,共3页Jiangsu Medical Journal

基　　金：国家自然科学基金项目(82274190)。

摘　　要：目的 探讨举宫杯在Ⅱ、Ⅲ型剖宫产瘢痕妊娠患者宫腹腔镜手术中的应用。方法 行宫腹腔镜手术联合子宫动脉栓塞术的Ⅱ、Ⅲ型剖宫产瘢痕妊娠患者50例,分为两组,观察组30例,使用举宫杯分离子宫膀胱反折腹膜;对照组20例,直接分离子宫膀胱反折腹膜,未放置举宫杯。比较两组出现膀胱损伤比例、手术时间、术中出血量、人绒毛膜促性腺激素(HCG)恢复正常时间和月经恢复时间。结果 两组患者年龄、孕次、剖宫产次数、末次剖宫产至今时间、BMI、术前HCG水平、HCG恢复正常时间和术后月经恢复时间均无统计学差异(P>0.05)。观察组术中无膀胱损伤,对照组术中膀胱损伤1例。观察组术中出血量为(37.78±16.30)mL,少于对照组的(116.15±24.27)mL,观察组手术时间为(119.44±28.15)min,长于对照组的(70.38±17.07)min(P<0.05)。结论 Ⅱ、Ⅲ型剖宫产瘢痕妊娠患者宫腹腔镜手术中,应用举宫杯能充分暴露子宫膀胱反折腹膜,避免损伤膀胱和减少术中出血。Objectivee To investigate the application of uterine cup during hysteroscopy and laparoscopy in the patients with type II or II Cesarean scar pregnancy.Methods Fifty patients with type II or II Cesarean scar pregnancy undergoing hysteroscopy and laparoscopy combined with uterine artery embolization were divided into two groups.During separating and pushing down the uterovesical peritoneal reflection by laparoscopy,an uterine cup was placed in group A(30 cases),which was not placed in group C(20 cases).The proportion of bladder injury,operation time,intraoperative blood loss,human chorionic gonadotropin(HCG)recovery time and postoperative menstrual recovery time were compared between the two groups.Results There were no significant differences in age,gravidity and parity history,Cesarean section times,period since the last Cesarean section,BMI,HCG level,HCG recovery time and postoperative menstrual recovery time between the two groups(P>0.05).Bladder injury in one patient occurred in group C and no patient with bladder injury was seen in group A.Intraoperative blood loss was less in group A than that in group C[(37.78±16.30)mL vs.(116.15±24.27)mL] and the operation time was longer in group A than that in group C[(119.44±28.15)minutes vs.(70.38±17.07)minutes](P<0.05).Conclusion During hysteroscopy and laparoscopy for type II or I Cesarean scar pregnancy,the use of uterine cup can make the uterovesical peritoneal refection fully exposed,effectively avoid bladder injury and reduce the intraoperative bleeding.

关 键 词：宫腹腔镜手术 剖宫产瘢痕妊娠 膀胱损伤 举宫杯 

分 类 号：R713[医药卫生—妇产科学]