经阴道前穹隆的剖宫产瘢痕妊娠病灶清除术

目的探讨经阴道前穹隆的剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)病灶清除术的应用价值。方法我院2011年3月～2012年2月共收治CSP 12例,停经时间41～71 d,(62.3±16.9)d。超声子宫峡部剖宫产切口处妊娠囊样包块最大直径17～42 mm,(30.2±13.0)mm,其中4例探及心管搏动。均经阴道前穹隆行病灶清除术,局部多点注射甲氨蝶呤(MTX)50 mg。结果 12例均手术成功,无并发症,出院前复查B超均提示子宫前壁下段剖宫产切口瘢痕部位包块消失,术后血β-hCG恢复正常时间10～23 d,术后均无月经淋漓、月经量改变等异常情况。结论经阴道前穹隆的CSP病灶清除术联合局部MTX注射,可以一次性清除病灶,手术操作微创、简单、并发症少。

Transvaginal Removal of Cesarean Scar Pregnancy via the Anterior Fornix

Objective To evaluate transvaginal removal of cesarean scar pregnancy(CSP) via the anterior fornix.Methods This was a retrospective study on 12 patients with CSP enrolled from March 2011 to February 2012.In the patients,the mean amenorrhea period was(62.3±16.9) days(ranged from 41 to 71 days),and the mean maximum diameter of the CSP cystic mass at the uterine isthmus was(30.2±13.0) mm(ranged from 17 to 42 mm) shown by ultrasonography,which detected fetal heart beat in 4 of the cases.After removing the CSP mass,we injected methotrexate(MTX,50 mg) locally at multi points.Results The procedure was completed in all the patients without causing complications.Re-examination by ultrasonography before discharge from the hospital showed that the CSP mass was disappeared in all the patients,and the level of serum β-hCG recovered to a normal range in 10 to 23 days.No patients had abnormal menstruation.Conclusion Transvaginal removal of CSP via the anterior fornix combined with local injection of MTX is an effective,minimally invasive,simple procedure with few complications.