腹腔镜手术治疗大病灶剖宫产瘢痕妊娠2例报告

2010年9月～2011年9月,对2例大病灶（直径8 cm）剖宫产瘢痕妊娠（cesarean scar pregnancy,CSP）,先行子宫动脉栓塞（uterine artery embolization,UAE）联合动脉内注入甲氨蝶呤（methotrexate,MTX）,术后10天行腹腔镜手术切除妊娠病灶、修复子宫。2例均在UAE联合动脉内注入MTX后获得妊娠病灶的有效抑制（病灶大小分别由8.05 cm×6.20 cm、8.80 cm×6.20 cm缩小至7.1 cm×6.0 cm、7.0 cm×5.2 cm,血β-hCG水平分别由10 001.63 mIU/ml、6112 mIU/ml下降至1278.77 mIU/ml、818.06 mIU/ml）,腹腔镜手术顺利,术中出血分别约为80 ml、100 ml,无中转开腹,未出现手术并发症,血β-hCG分别于术后第10、14天降至正常,术后月经规律。

Laparoscopic Management of Cesarean Scar Pregnancy with Large Gestational Mass: Report of 2 Cases

From September 2010 to September 2011, two cases of cesarean scar pregnancy （CSP） with large gestational mass （8.0-cm in diameter） received laparoscopic surgery following the steps： uterine artery embolization （UAE） combined local methotrexate （MTX） injection, followed by laparuscopic removal of the gestationnal tissue and repair of the uterus. The gestational mass got efficient inhibition after the UAE combined with local MTX injection （ decreased from 8. 05 cm ×6.20 cm and 8.80 cm × 6.20 cm to7.1 cm×6.0 cm and 7.0 cm×5.2 cm in size; and declined from 10 001.63 mIU/ml and 6112 mlU/ml to 1278.77 mlU/ml and 818.06 mIU/ml in β-hCG level）. The laparoscopic surgery was completed successfully with the blood loss at 80 ml and 100 ml, respectively, without need for laparotomy or any complications occurred. Serum level of β-hCG declined to a normal range within 10 and 14 days respectively after the operation, and regular menstruation was then achieved.