【摘要】 目的总结宫腔镜治疗剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)失败的经验教训,探讨宫腔镜治疗剖宫产瘢痕妊娠的最佳适应证。方法 2014年3月至2016年12月采用宫腔镜下妊娠病灶切除术治疗CSP 43例,其中Ⅰ型25例,Ⅱ型16例,Ⅲ型2例。共失败7例(Ⅱ型5例,Ⅲ型2例),其中4例术中急症行子宫动脉栓塞术,其后行清宫术;2例转行腹腔镜下妊娠病灶清除术;1例转行经阴道妊娠病灶清除术。结果 7例患者均成功清除病灶,保留子宫。术后1个月血β-h CG均降至正常,26~53 d月经复潮。结论宫腔镜下妊娠病灶清除术适用于Ⅰ型和部分Ⅱ型瘢痕妊娠。术前全面评估,备好相应预案可以避免因宫腔镜手术选择不当造成的大出血,避免手术失败,减少患者损失,提高宫腔镜手术的成功率。更多还原

【Abstract】 Objective To summarize the experiences and lessons in failed hysteroscopic treatment for the cesarean scar pregnancy cases,and investigate the best indications. Methods A total of 43 patients with CSP were enrolled,who received treatment from March 2014 to December 2016 in the Qingdao Municipal Hospital. Among them,there were 25 cases of type Ⅰ,16 cases of type Ⅱ and 2 cases of type Ⅲ.The surgery failed in 7 cases. There were 2 cases of conversion to laparoscopic surgery,1 case of conversion to vaginal operation,4 cases of conversion to uterine artery embolization. Results The lesions were all cleared,and the patients’ uterus was preserved. The serum β-hCG levels of all patients returned normal within 1 month after the treatment. The time of re-menstruation ranged 26-53 days.Conclusion Hysteroscopy curettage is suitable for type Ⅰ and partial type Ⅱ endogenous cesarean scar pregnancy.By comprehensive evaluation before the surgery and preparing alternative plans,we can avoid losses from blind surgery and increase the successful rate of hysteroscopy curettage in CSP.更多还原