宫腔镜下清宫术治疗剖宫产瘢痕妊娠疗效分析.docVIP

宫腔镜下清宫术治疗剖宫产瘢痕妊娠疗效分析 　　doi：10.3969/j.issn.1007-614x.2014.11.43 　　摘 要 目的：探讨宫腔镜下行清宫术对于治疗剖宫产瘢痕部位妊娠的效果。方法：收治剖宫产子宫切口瘢痕妊娠患者32例，均接受宫腔镜下清宫术，对其临床病例资料进行回顾性分析。术中宫颈注射缩宫素及垂体后叶素，术毕给予甲氨蝶呤宫颈注射，术后复查血β-HCG及盆腔彩超检查。结果：32例患者均一次性手术成功，无中转开腹、子宫穿孔发生。二者瘢痕厚度、血β-HCG值及血流阻力指数（RI）比较，差异均无统计学意义（P0.05）；术后3天血β-HCG下降平均（85.1%±10.3%）；术后血β-HCG在7～23天降至正常。结论：宫腔镜下清宫术对于治疗剖宫产瘢痕妊娠具有创伤小、手术时间短、出血少、术后恢复快、住院时间短的特点，是微创、直接、准确、有效的治疗方法。 　　关键词 宫腔镜 清宫术 剖宫产瘢痕妊娠 　　Curative effect analysis of hysteroscopic curettage for the treatment of cesarean scar pregnancy 　　Mao Lili，Yang Yapei 　　The First Peoples Hospital of Zhengzhou city，Henan 450000 　　Abstract Objective：To explore the effect of hysteroscopic curettage for the treatment of cesarean scar pregnancy.Methods：32 patients with cesarean scar pregnancy were selected，they underwent hysteroscopic curettage.The clinical data of these patients were retrospectively analyzed.In the operation，all the patients were given the cervical injection of oxytocin and vasopressin；after operation，all the patients were given methotrexate cervical injection；after the operation，we checked the blood β-HCG and pelvic ultrasonography.Results：32 patients were all one-time successful without conversion to laparotomy and perforation of the uterus.The scar thickness，serum β-HCG and blood flow resistance index（RI） were compared，the differences were not significant（P0.05）.At 3 days after operation，serum β-HCG was decreased by an average of 85.1%±10.3%；at 7 to 23 days after operation，serum β-HCG was decreased to normal.Conclusion：There are many characteristics of application of hysteroscopic curettage for the treatment of cesarean scar pregnancy，such as little trauma，short operation time，less bleeding，faster postoperative recovery and shorter hospitalization time.It is a minimally invasive，direct，accurate and effective treatment method. 　　Key words Hysteroscopy；Dilatation and curettage；Cesarean scar pregnancy 　　剖宫产子宫切口瘢痕妊娠（CSP）是一种异位妊娠，它是指在既往有剖宫产史的妇女再次怀孕后，孕囊在子宫切口的瘢痕处着床，导致发生一系列的病理反应的情况，它属于一种剖宫产远期