摘要
目的总结经阴道手术治疗剖宫产瘢痕妊娠（cesarean scar pregnancy,CSP）失败的经验。方法 2011年3月~2015年4月,采用经阴道子宫下段切开取胚＋子宫缺陷修补术治疗CSP 98例,其中9例治疗失败。4例改行子宫动脉栓塞＋清宫术,2例中转腹腔镜手术,1例中转开腹手术,1例改行病灶抽吸术局部注射甲氨蝶呤（MTX）,1例术后血β-h CG下降缓慢,肌注MTX治疗。结果 9例均病灶清除,保留子宫,术后1个月内血β-h CG降至正常,30~50 d[（40.1±7.2）d]月经复潮。结论阴式手术适用于阴道宫颈暴露良好、包块〈4 cm的外生型CSP,术前全面评估,备好相关预案,可以避免因盲目手术造成的损失,提高阴式手术治疗CSP的成功率。
Objective To study lessons of failed transvaginal removal of ectopic pregnancy tissue in the treatment of caesarean scar pregnancy（ CSP）. Methods A total of 98 patients with CSP were enrolled from March 2011 to April 2015. The surgery was failed in 9 cases. There were 4 cases of conversion to uterine artery embolization,2 cases of conversion to laparoscopic surgery,1 case of conversion to open surgery,1 case of conversion to aspiration with local injection of MTX,and 1 case of postoperative injection of MTX intramuscularly due to a slow drop of serum β-h CG. Results The lesions were all cleared,and patients＇ uterus were preserved. The serum β-h CG levels of all the patients became normal within 1 month after the treatment. The time of re-menstruation was（ 40. 1 ± 7. 2） days（ range,30- 50 days）. Conclusions Vaginal surgery is suitable for exogenous type of CSP with good exposure of the vagina and cervix and the cystic mass〈 4 cm. By comprehensive evaluation before the surgery and preparing alternative plans,we can avoid losses from blind surgery and increase the successful rate of vaginal surgery in cesarean section scar pregnancy.
出处
《中国微创外科杂志》
CSCD
北大核心
2016年第5期432-435,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
剖宫产瘢痕妊娠
经阴道手术
Cesarean scar pregnancy
Transvaginal surgery
