摘要
目的探讨腹腔镜在治疗子宫瘢痕部位妊娠(cesarean scar pregnancy,CSP)处理中的应用价值。方法回顾性分析武汉大学中南医院16例CSP患者的临床资料。依超声结果对CSP分型及分级,相应行腹腔镜监测下刮宫术或病灶切除术并缝合修补切口,腹腔镜下双侧子宫动脉阻断术和/或子宫下段Foley水囊压迫法止血。术后随访血β-hCG及月经情况。结果 16例手术均成功。7例选择腹腔镜监测下刮宫术,手术平均出血量(74±23)ml,平均时间(31±15)min,4例同时Foley水囊压迫法止血;9例腹腔镜镜下病灶切除术并缝合修补切口,手术平均出血量(199±35)ml,平均时间(65±25)min,7例行腹腔镜下双侧子宫动脉阻断术止血,其中2例需同时行Foley水囊压迫法止血。16例患者病理结果均符合CSP。住院日3～7d,术后监测血β-hCG,4周内均降至正常。术后4～9周月经恢复来潮,月经规律。结论彩色超声对CSP治疗方案有指导意义。腹腔镜下根据子宫下段切口瘢痕处浆膜层、肌层情况选择个体化治疗,可有效清除病灶并快速止血,是目前可选择的安全有效的治疗方法。
Objective To explore the value of laparoscope in the treatment of cesarean scar pregnancy（CSP）.Methods Clinical data of 16 cases with cesarean scar pregnancy in Zhongnan Hospital Wuhan university from January 2005 to February 2012 were retrospectively analyzed.Results There were 7 cases underwent Dilatation and Curettage assisted by laparoscopy surveillance. 4 patients required hemostasis with Foley bladder at the meanwhile. The CSP site was incised and the uterine defect was repaired laparoscopically in the other 9 cases. 7 patientsunderwent bilateral uterine artery ligation by laparoscopy, 2 patients required hemostasis with Foley bladder at the meanwhile. The procedures were completed successfully in all the cases without complications. The 16 patients were discharged in 3~7 days after the operation.Their serum levels of β-hCG declined to normal range in 4 weeks and menstruation recovered within 4~9 weeks.Conclusion Dilatation and curettage assisted by laparoscopic surveillance or laparoscopic wedge excision of gestational mass followed by uterine defect repair ment are effective treatment for caesarean scar pregnancy.
出处
《中国妇产科临床杂志》
2013年第1期34-36,共3页
Chinese Journal of Clinical Obstetrics and Gynecology
