宫腔放置水囊联合腹腔镜下子宫病灶切除在抢救剖宫产瘢痕妊娠初治出血中的应用

目的探讨官腔放置水囊联合腹腔镜下子宫病灶切除在抢救剖宫产瘢痕妊娠初治出血中的可行性及价值。方法2010年10月～2019年6月，对5例初治出血的剖宫产瘢痕妊娠，先在宫腔内放置水囊压迫止血，然后立即行腹腔镜下剖宫产瘢痕妊娠病灶切除及缝合修补。结果5例均获成功，无中转开腹及手术并发症。手术时间35～50min，平均42min。术中出血量10～30ml，平均21ml。术后4周内血β-hCG均降至正常，月经规律来潮。结论官腔放置水囊联合腹腔镜子宫病灶切除具有微创、疗效确切等优点，是抢救初治出血的剖宫产瘢痕妊娠病例的有效方法。

Application of Water Sac Placement in uterine Cavity and Laparoscopic Ectopic Gestational Tissue Excision for Hemorrhage of Cesarean Scar Pregnancy after Initial Treatment Failure

Objective To investigate the feasibility and the value of water sac placement in uterine cavity and laparoscopic ectopic gestational tissue excision in treating hemorrhage of cesarean scar pregnancy after initial treatment failure. Methods From October 2010 to June 2013, five cesarean-scar-pregnant patients with hemorrhage after initial treatment were re-treated by placing water sac in uterine cavity and laparoscopy in our department＇. During the operation, the entire lesion was resected and sutured under laparoscopy. Results The procedure was successfully completed under laparoscopy without surgical complications or conversion to open surgery in all the cases. The operation time ranged from 35 min to 50 min （mean, 42 min） and intraoperative blood loss was between 10 ml and 30 ml （mean, 21 ml）. Four weeks after the treatment, all the patients achieved normal serum level of β-hCG and regular menstruation. Conclusions The placement of water sac in uterine cavity and laparoscopic ectopic gestational tissue excision is minimally invasive and feasible. It is an effective method in treating hemorrhage of cesarean scar pregnancy after initial treatment failure.