宫腔镜手术治疗剖宫产术后子宫瘢痕妊娠64例临床分析

目的 探讨宫腔镜手术治疗剖宫产术后子宫瘢痕妊娠(CSP)的合理方案.方法 回顾性分析中国医科大学附属盛京医院2006年1月至2009年4月收治的64例CSP患者的治疗情况.27例患者入院前曾在外院误诊为早孕、不全流产、宫颈妊娠等而采用不同的治疗(均失败),37例患者因阴道不规则流血且有剖宫产史首诊于本院.所有患者入院后行血清人绒毛膜促性腺激素β亚单位(β-hCG)测定、阴式三维彩超检查.结果 63例CSP患者采用超声监测下宫腔镜CSP病灶切除术,1例采用腹腔镜监测下宫腔镜CSP病灶切除术,均收到了良好的治疗效果.27例外院转诊患者经本院宫腔镜手术处置后血清β-hCG降至正常时间及包块完全吸收时间明显缩短分别为(11±4)、(35±10)d],而本院首诊患者分别为(22±7)、(49±11)d,分别比较,差异均有统计学意义(P<0.05).64例CSP患者中,有7例进行了二次宫腔镜手术;1例经术后病理检查证实为绒毛膜癌,其余患者术后诊断与术前的CSP诊断符合.结论 有剖宫产史的妇女再次妊娠时,有发生CSP的可能,诊断时要注意CSP的临床特点,减少误诊,并对确诊病例采取个体化治疗;超声监测下宫腔镜CSP病灶切除术是治疗CSP的有效措施,病灶切除确切,可保留子宫.经术后随访,血清β-hCG水平下降迅速,局部包块吸收较快.

Clinical analysis of hysteroscopic surgery for cesarean scar pregnancy in 64 cases

Objective To explore the rationale therapy method of hysteroscopic surgery for cesarean scar pregnancy. Methods A retrospective review of medical records of 64 patients with cesarean scar pregnancy admitted in Shengjing Hospital of China Medical University from January 2006 to April 2009 was performed, 27 cases out of them were referred from other institutions, and received various interventions before admission, while 37 cases were admitted to our hospital without prior treatments. Results The diagnosis was confirmed by serum human chorionic gunadotropin-beta subunit (β-hCG) and ultrasound.Sixty-three patients were removed of conceptive tissues underwent hysteroscopy assisted by ultrasonic guidance, while 1 patient underwent hysteroscopic removal of conceptive tissues assisted by laparoscopic surveillance. Seven cases of sixty-four were experienced second salvage operation. Pathological examinations were performed for all cases and 1 case was diagnosed to be choriocarcinoma. Conclusion Hysteroscopic removal of conceptive tissues implanted in the cesarean section scar seems to be a feasible and safe procedure that might be considered as a treatment option and it should be monitor the levels of β-hCG and the residual lesions after surgery.