腹腔镜对剖宫产瘢痕妊娠的诊治价值

目的：探讨腹腔镜对剖宫产瘢痕妊娠（ cesarean scar pregnancy ，CSP）的诊治价值。方法回顾分析2008年2月～2011年12月15例CSP入院即行腹腔镜治疗（腹腔镜监护下清宫或腹腔镜病灶切除及修补术）和12例经保守性治疗（药物或者超声引导下清宫）失败转腹腔镜治疗的临床资料。结果首选腹腔镜手术治疗15例中，1例因探查发现瘢痕缺损较大，出血多，中转开腹；9例行腹腔镜下病灶切除及修补术，其中3例同时行子宫动脉阻断术（uterine artery embolization，UAE），2例同时行宫腔镜检查；5例行腹腔镜监护下清宫，其中2例同时行宫腔镜检查术。15例均治愈并保留子宫，术后平均29 dβ-hCG降至正常，平均2个月月经复潮，半年后3例再次妊娠（其中1例足月时剖宫产分娩）。保守性治疗失败12例中，7例在腹腔镜监护下清宫，其中1例同时行宫腔镜检查；5例行腹腔镜下病灶切除及修补术，其中2例行UAE，1例行宫腔镜检查术。12例均治愈并保留子宫，术后平均30 dβ-hCG降至正常，平均1个月月经复潮，半年后2例再次妊娠。结论腹腔镜手术能尽早明确诊断，有多种手术方式选择，降低CSP诊治过程中的风险，可以修复瘢痕部位缺陷，是诊断和治疗CSP的理想方法。

Laparoscopic Diagnosis and Management of Cesarean Scar Pregnancy

Objective To investigate the value of laparoscopy in the diagnosis and management of cesarean scar pregnancy （CSP）. Methods A retrospective analysis was carried out on the clinical data of 27 patients with CSP from February 2008 to December 2011 in our hospital , including 15 cases of laparoscopic surgery upon admission and 12 cases of laparoscopic surgery following the failure of conservative therapy .Laparoscopic surgery included curettage under laparoscopic supervision and laparoscopic focal resection and uterine repair .Conservative treatment included drug administration or ultrasound-guided curettage . Results In the 15 patients who chose laparoscopic surgery initially , one case was converted to laparotomy due to large scar defect and heavy bleeding;9 cases underwent laparoscopic excision and uterine repair , including uterine artery embolization （ UAE） in 3 cases, and hysteroscopic examination in 2 cases;the remaining 5 cases received curettage under laparoscopic supervision , including simultaneous hysteroscopic examination in two cases .All the 15 patients were cured and the uteri were all preserved;β-hCG went down to normal level after 29 d on average and normal menstrual cycle resumed in two months on average , in which three patients got pregnant naturally after six months including one case of cesarean delivery at full term .In the 12 cases of conservative treatment failure , 7 patients underwent curettage under laparoscopic supervision , including hysteroscopic examination in one case; the remaining five cases underwent laparoscopic excision and repair , in which 2 patients underwent UAE and one patient received hysteroscopy simultaneously . All the 12 patients were cured and the uteri were all preserved .β-hCG went down to normal level after 30 d on average and normal menstrual cycle resumed in one month on average , in which two patients got pregnant naturally after six months . Conclusions Laparoscopic surgery can confirm the diagnosis of CSP as early as possible to ensure the optimal choice of surgical procedures , thus reducing the risk of CSP diagnosis and treatment and repairing scar defects .It is an ideal procedure for the diagnosis and treatment of CSP.