宫、腹腔镜联合手术治疗剖宫产切口妊娠的疗效分析.docVIP

宫、腹腔镜联合手术治疗剖宫产切口妊娠的疗效分析 　　摘要：目的 探讨宫、腹腔镜联合手术治疗剖宫产切口妊娠（CSP）的安全性、有效性及可行性。方法 选择于2014年1月～2015年10月在我院住院的CSP患者50例分为3组，A组（20例）血HCG10000 mIU/ml，先给予甲氨蝶呤肌注，待血HCG10000 mIU/ml，仍直接采用宫、腹腔镜手术。对术中出血量、手术时间、住院时间、手术成功率等进行统计学分析。结果 三组患者均治愈出院，A、B组手术时间、出血量均明显低于C组，成功率高于C组，差异有统计学意义（P0.05）；B组住院时间明显高于C组，但手术时间、出血量均低于C组，差异有统计学意义（P0.05）。结论 对血HCG较低病例，或血β-HCG较高患者先采用甲氨蝶呤肌注降低血HCG后，再行宫、腹腔镜手术治疗CSP，是安全、有效、可行的治疗方案，值得推广。 　　关键词：剖宫产切口妊娠；腹腔镜；宫腔镜；甲氨蝶呤 　　Clinical Analysis of Hysteroscopy Combined with Laparoscopy in the Treatment of Cesarean Section Incision Pregnancy 　　CHEN Zhi-gang 　　（Obstetrics and Gynecology Department，Mianyang Third Peoples Hospital，Mianyang 621000，Sichuan，China） 　　Abstract：Objective To evaluate the safety，feasibility and effectiveness of Laparoscopic assisted hysteroscopy operation on CSP patients.Methods 50 CSP patients from january 2014 to october 2015 in our hospital were divided into three Groups.Group A（20 cases）who were HCG10000mIU/ml，were treated by Methotrexate before Laparoscopic assisted hysteroscopy operation.Group C（15 cases） who were HCG10000mIU/ml，were direct treated with Laparoscopic assisted hysteroscopy operation.Results Three groups prtients were hospital cures.Group A and B bleeding volume and opration time were less than Group C，the success rate were higher than Group C（P0.05）.The length of stay of Group B were longer than Group C，but bleeding volume and opration time were less than Group C（P0.05）.Conclusion It is safety，feasibility and effectiveness to use Laparoscopic assisted hysteroscopy operation on CSP patients，which HCG is in low level，or treated by Methotrexate of HCG who is in high level patients.This treatment is worth of popularizing. 　　Key words：Cesarean scar pregnancy；Laparoscopic operation；Hysteroscopy；Methotrexate 　　剖?m产切口妊娠（caesarean scar pregnancy，CSP）是一种特殊部位的异位妊娠，在临床上常被误诊为宫颈妊娠、难免流产或不全流产，在流产或清宫时可发生致命的大量出血，危及患者生命。目前对剖宫产切口妊娠的治疗国际上尚无统一的治疗方法。故选择安全、有效、可行的治疗方法可减少患者并发症，减轻痛苦。腹腔镜具有微创、术后恢复快、疗效确切等优势。对笔者所在医院住院治疗的CSP患者，采取宫腹腔镜联合手术治疗，效果满意，现报告如下。 　　1 资料与