腹腔镜子宫动脉阻断及子宫病灶切除在初治失败的剖宫产瘢痕妊娠中的应用

目的探讨腹腔镜下子宫动脉阻断及子宫病灶切除在初治失败的剖宫产瘢痕妊娠中应用的可行性及价值。方法2006年5月～2009年5月我院对4例经外院治疗失败的剖宫产瘢痕妊娠,采用在腹腔镜下先分离出双侧子宫动脉并进行动脉阻断,然后行剖宫产瘢痕妊娠病灶切除及缝合修补。结果4例均在腹腔镜下成功行子宫动脉阻断及病灶切除修补,无中转开腹及手术并发症。手术时间60～80min,术中出血量30～70ml。术后血hCG4周内均降至正常,月经规律来潮。结论腹腔镜下子宫动脉阻断及子宫病灶切除具有微创、疗效确切等优点,将成为治疗初治失败的剖宫产瘢痕妊娠病例的最佳方法。

Laparoscopic Uterine Arteries Ligation and Ectopic Gestational Tissue Excision in Cesarean-Scar Pregnancy after Initial Treatment Failure

Objective To investigate the feasibility and the value of laparoscopic uterine arteries ligation and ectopic gestational tissue excision in the treatment of cesarean-scar pregnancy with initial treatment failure.Methods From May 2006 to May 2009,four cesarean-scar-pregnant patients with initial treatment failure were re-treated by laparoscopy in our department.During the operation,the uterine arteries were separated and ligated by laparoscopy and then the entire lesion was wedge resected.ResultsThe procedure was successfully completed by laparoscopy without surgical complications or conversion to open surgery in all the cases.The operation time ranged from 60 min to 80 min,and intraoperative blood loss was between 30 ml and 70 ml.Four weeks after the treatment,all the patients achieved normal serum level of HCG and regular menstruation.Conclusion With advantages in minimal invasion and satisfactory effect,laparoscopic uterine arteries ligation and ectopic gestational tissue excision can be the best choice for the treatment of cesarean-scar pregnancy with initial treatment failure.