宫腔镜电切术用于治疗胎盘残留的临床价值

目的探讨宫腔镜电切术（TCRPR）用于治疗胎盘残留的临床价值。方法自2003年3月至2006年4月间,实施TCRPR14例,其中足月产后胎盘残留3例,晚期流产8例,病理妊娠中期引产3例。血清人绒毛膜促性腺激素β亚单位（β-hCG）〉80U／L者,给予米非司酮25mg口服,每日3次,同时每隔3d给予米索前列醇600μg口服,共3次,每周复查β-hCG和B超;β-hCG〉150U／L者,给予甲氨蝶呤深部肌内注射,剂量为1mg／m^2。采用电切（双极汽化电切）＋钳夹交替的方法,术毕宫腔内置圆形宫内节育器,术后给予戊酸雌二醇1～2mg／d,从术后3～5d开始服用,21d为1个疗程,最后5d加服醋酸甲羟孕酮10mg／d,治疗2～4个疗程。结果在B超严密监护下,14例TCRPR均顺利完成,无一例出现并发症。术后随访6个月～2年,所有患者月经基本均恢复正常,其中有3例分别于术后4．6和7个月时妊娠并均已顺利分娩。结论TCRPR治疗胎盘残留具有创伤小、见效快、并发症少的特点。

Clinical value of transcervical resection under hysteroscope for placental remnants

OBJECTIVE: To study the clinical value of transcervical resection under hysteroscope in treatment of placental remnants. METHODS: From March 2003 to April 2006, 14 cases of placental remnants were treated with transcervical resection under hysteroscope. They included 3 cases of term birth, and 11 cases of midtrimester induction of labor. Drug pretreatment was performed for those who had more than 80 U/L of blood beta-human chorionic gonadotropin (beta-hCG) level, including mifepristone (RU486), Chinese herbs and methotrexate (MTX). RU486 was taken orally at 25 mg, three times daily and misoprostol was given 600 microg at one dose on the third day. MTX was given by deep intramuscular injection at 1 mg/m(2) if beta-hCG was higher than 150 U/L. Bipolar evaporation was used in the operation with alternation of resection and forceps holder under ultrasonographic supervision. After operation a circular contraceptive device was placed followed by hormone periodic treatment such as estradiol valerate for 2 - 4 months. RESULTS: Under the monitoring by ultrasonography, 14 operations were all performed smoothly. The follow-up was from 6 months to 2 years. Menstruations in almost all the cases were recovered, and 3 cases of those were pregnant and delivered smoothly 4, 6 and 7 months after operation. CONCLUSION: The transcervical resection under hysteroscope is useful in treatment of placental remnants with obvious effects, little trauma and few complications.