腹腔镜治疗剖宫产瘢痕部位妊娠临床分析

目的:探讨腹腔镜在治疗剖宫产瘢痕部位妊娠(CSP)的应用价值。方法:回顾分析2008年3月～2012年8月经腹腔镜诊治10例CSP患者的病例资料。结果:10例患者均在腹腔镜下完成手术治愈并保留子宫,手术成功率100%,平均手术时间(90.7±18.9)min,平均手术出血(241.6±285.3)ml,均无中转开腹。1例行宫腔镜检查及腹腔镜监护下负压吸宫术、瘢痕修补术,8例阻断双侧子宫动脉后行局部病灶清除及瘢痕修补术。术后血人特异性绒毛膜促性腺激素(β-HCG)降至100 mIU/ml以下时间平均(15.3±8.9)天,超声显示子宫恢复正常时间平均(20.1±6.8)天。1例在阻断双侧子宫动脉后行局部病灶清除术,超声显示90天后子宫恢复正常。结论:腹腔镜下局部病灶清除及瘢痕修补术是治疗CSP的理想方法。

Clinical analysis on laparoscope for treatment of cesarean scar pregnancy

Objective:To explore the application value of laparoscope for treatment of cesarean scar pregnancy(CSP).Methods:The clinical data of ten CSP patients who were treated with laparoscope from March 2008 to August 2012 were analyzed retrospectively.Results:The laparoscopic surgery was completed successfully and uteri were reserved in ten patients,the successful rate of surgery was 100%,the mean operation time was(90.7±18.9) minutes,the mean amount of intraoperative bleeding was(241.6±285.3) ml,no patient converted to laparotomy.One patient underwent laparoscopy and negative pressure uterine aspiration under monitoring of laparoscope,scar neoplasty;eight patients underwent local focus debridement and scar neoplasty after blocking bilateral uterine arteries.After surgery,the mean time for blood β-human chorionic gonadotropin(β-HCG) falling to below 100 mIU/ml was(15.3±8.9) days,ultrasound showed that the mean time for uterus returning to normal was(20.1±6.8) days.Ultrasound showed that uterus returned to normal at 90 days after local focus debridement after blocking bilateral uterine arteries in one patient.Conclusion:Laparoscopic local focus debridement and scar neoplasty are ideal methods for treatment of CSP.