宫腔镜联合Foley双腔导尿管球囊治疗剖宫产瘢痕妊娠21例

目的探讨宫腔镜联合Foley双腔导尿管球囊治疗剖宫产瘢痕妊娠（caesareanscarpregnancy，CSP）的临床效果。方法2008年1月～2013年10月，B超确诊CSP21例，其中11例血β-hCG0～500IU／L口服米非司酮后2d手术，10例血β-hCG〉500IU／LVI服米非司酮联合注射甲氨蝶呤后7～14d手术，均采用宫腔镜电切联合Foley双腔导尿管球囊压迫止血。结果19例一次性顺利完成官腔镜手术，手术时间15～42min；1例二次宫腔镜手术，1例发生子宫穿孔改腹腔镜手术。18例术前β—hCG0—500IU／L者，术中出血量20～100ml；3例β-hCG1085～2760IU／L者术中出血量200～800ml。16例门诊随访2～4周血β-hCG下降至正常，43～56d恢复月经，经量无明显改变。5例电话随访，术后39～50d月经恢复正常。结论宫腔镜电切联合球囊治疗CSP安全、有效。

Management of Caesarean Scar Pregnancy by Hysteroscopy Combined with Foley Balloon Tamponade

Objective To investigate the clinical effect of hysteroscopy combined with foley balloon tamponade in the management of caesarean scar pregnancy （CSP）. Methods Twenty-one cases were diagnosed as having CSP by ultrasound examinations from January 2008 to November 2013. Among them, 11 cases with serum β-hCG below 500 IU/L underwent the surgery after taking mifepristone for 2 days, while 10 cases with serum 3-hCG over 500 IU/L underwent surgery after injection of MTX combined with oral administration of mifepristone for 7 - 14 days. All the cases were treated by hysteroscopy combined with foley balloon tamponade. Results The hysteroscopic operation was successfully conducted in 19 of 21 cases, with the operate time ranged 15-42 min. One case was given a second hysteroscopy and one case required a secondary laparoscopic procedure for the uterine perforation. In 18 cases with preoperative serum β-hCG below 500 IU/L, the intraoperative blood loss was 20 -100 ml, while in another 3 cases with preoperative serum β-hCG 1085 -2760 IU/L, the blood loss was 200 -800 ml. Follow-up examinations at clinic for 2 -4 weeks in 16 cases showed levels of β-hCG declined to normal and recovery of menstruation at 43 -56 postoperative days with normal menses amount. Conclusion Hysteroscopy combined with foley balloon tamponade in the management of CSP offers advantages of safety and effectiveness, which is deserved to clinical application.