宫、腹腔镜在治疗剖宫产瘢痕部妊娠中的应用价值

目的探讨剖宫产瘢痕部妊娠（caesarean scar pregnancy,CSP）的诊断及宫、腹腔镜治疗的可行性。方法回顾性分析2000年1月~2010年8月31例子宫下段剖宫产瘢痕部妊娠患者的临床资料。V ial分型Ⅰ型18例,Ⅱ型13例。Ⅰ型应用宫腔镜行妊娠病灶切除术,Ⅱ型应用腹腔镜行子宫瘢痕部位病灶楔形切除＋子宫修补术。结果应用宫腔镜行妊娠病灶局部切除术18例,其中2例包块直径〉3 cm,改行腹腔镜下局部病灶楔形切除＋子宫修补术。应用腹腔镜治疗13例,其中2例因局部包块直径〉5 cm,中转开腹行病灶楔形切除术＋子宫修补术。31例均痊愈出院。无严重并发症发生,术后血β-hCG降至正常时间15~30 d,（20.7±5.3）d,月经周期均恢复正常。结论 CSP如能早期诊断,应用腔镜治疗是可行的,能保留患者生殖功能,值得临床推广。

Value of Hysteroscopy and Laparoscopy for Cesarean Scar Pregnancy

Objective To evaluate the feasibility of hysteroscopy and laparoscopy in the diagnosis and treatment of caesarean scar pregnancy（CSP）.Methods A total of 31 cases of CSP,who received treatment in our hospital from January 2000 to August 2010,were enrolled in this retrospective study.Among the patients,18 cases who were classified as Type Vial Ⅰ,underwent hysteroscopy for lesion excision,and the other 13,who were Type Vial Ⅱ,received laparoscopic wedge excision combined with uterine repair.Results In the 18 patients who received hysteroscopy and lesion excision,2 patients had the lesion larger than 3 cm in diameter,and thus was converted to laparoscopic wedge excision combined with uterine repair.In the 13 patients who recieved laparoscopic surgery,2 patients were converted to open surgery for wedge excision combined with uterine repair because of local lesion larger than 5 cm in diameter.All the patients were cured without severe complications.Their postoperative β-hCG decreased to a normal range in 15 to 30 days with a mean of（20.7±5.3） days.Their menstrual cycles recovered as well.Conclusions If being diagnosed in an early stage,CSP can be cured by endoscopy with fertility of the patients preserved.