子宫动脉栓塞联合宫腔镜专用取物钳治疗 剖宫产瘢痕妊娠：附28例分析

Uterine artery embolism combined with forceps especially used in hysteroscopy for cesarean scar pregnancy: analysis of 28 cases

摘要:

目的 探讨子宫动脉栓塞联合宫腔镜专用取物钳在剖宫产瘢痕妊娠治疗中的作用。方法 回顾性分析2009年1月~2013年1月在该院行子宫动脉栓塞术后，于宫腔镜或宫腹腔镜联合监视下，以宫腔镜专用取物钳行病灶清除术的剖宫产瘢痕妊娠患者28例，观察分析其临床资料。结果 28例患者均接受双侧子宫动脉栓塞术，次日均采用宫腔镜专用取物钳行病灶清除术，其中17例患者行宫腹腔镜联合监视下手术，11例患者行宫腔镜监视下手术。所有患者平均年龄（30.90±3.28）岁，停经时间（51.47±6.42）d，剖宫产次数（1.20±0.41）次，距离前次剖宫产的时间（4.27±2.84）年，术前子宫前峡部肌层的厚度（3.75±1.70）mm，B超提示前峡部包块大小（28.71±13.25）mm，术前HCG值（22 822.66±19 664.71）mIU/mL，手术时间（41.85±9.91）min，术后24 h血红蛋白下降值（13.12±5.15）g/L、总住院时间（8.32±4.79）d，术后HCG下降至正常的时间（25.81±8.15）d。所有患者均一次手术获得成功，术后1周复查B超均未提示妊娠物残留，术中、术后无并发症。结论 子宫动脉栓塞联合宫腔镜专用取物钳治疗剖宫产瘢痕妊娠安全有效。

Abstract:

【Objective】 To investigate the effect of uterine artery embolism (UAE) combined with forceps especially used in hysteroscopy on cesarean scar pregnancy (CSP). 【Methods】 Twenty-eight cases of CSP were treated by UAE combined with clearance of lesions using forceps especially used in hysteroscopy in our department from January 2009 to January 2013, were retrospectively reviewed. 【Results】 After one day of UAE, all patients received clearance of lesions. Among these operations, 17 cases were guided by hysteroscopy-laparoscopy, while 11 cases were guided by hysteroscopy. Mean age of the patients was (30.9±3.28) years, mean gestational age was (51.47±6.42) days, mean caesarean section (CS) times was (1.2±0.41), mean time from CS to diagnosis was (4.27±2.84) years, mean myometrial thickness anterior to the CSP was (3.75±1.70) mm, mean size of the CSP mass was (28.71±13.25) mm, mean β-HCG level before surgery was (22822.66±19664.71) miu/mL, mean operative time was (41.85±9.91) min, mean decrease of hemoglobin 24h after surgery was (13.12±5.15) g/L, mean length of hospital stay was (8.32±4.79) days, mean time of β-HCG resolution was (25.81±8.15) days. All patients received clearance of lesions successfully without complications, and no residue was found by ultrasound one week after the surgery. 【Conclusion】 UAE combined with forceps that especially used in hysteroscopy seems to be a safe and effective procedure in the treatment of CSP.