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目的探讨宫腔镜及腹腔镜在剖宫产切口妊娠(cesarean scar pregnancy,CSP)诊断及治疗中的应用价值。方法回顾性分析2013年1月至2015年1月收治的血清人绒毛膜促性腺激素(HCG)>5 000 m IU/ml的CSP患者37例。患者入院后行血HCG测定和三维彩色超声多谱勒检查,均在腹腔镜下先行双侧子宫动脉结扎,随后对于内生型的患者行腹腔镜监护下宫腔镜下CSP病灶切除,而外生型的患者则行宫腹腔镜联合CSP病灶切除+剖宫产瘢痕修补术。结果本组中20例为外生型,17例为内生型。经宫腹腔镜联合治疗一次成功,术中出血量(83±32)ml,术后肛门排气时间(19.0±7.6)h,术后阴道流血时间(6.2±2.9)d,血清HCG降至正常时间(9.6±3.0)d,出院时间(4.2±1.8)d,无1例并发症发生。结论宫腹腔镜联合治疗剖宫产切口妊娠微创、术后恢复快、临床效果确切,是保留器官生殖功能的有效措施,值得在临床推广。
Objective To investigate the value of hysteroscopy and laparoscopy in the diagnosis and treatment of cesarean scar pregnancy (CSP). Methods A total of 37 CSP patients with serum human chorionic gonadotropin (HCG)> 5,000 mIU / ml were recruited from January 2013 to January 2015. Patients were admitted to hospital after blood HCG determination and three-dimensional color Doppler ultrasound examination, both in the laparoscopic bilateral uterine artery ligation, followed by endoscopic laparoscopic monitoring of patients underwent hysteroscopic CSP lesion resection, and outside Patients with genital laparoscopic cesarean section combined with CSP resection + cesarean scar repair. Results In this group, 20 cases were exogenous and 17 cases were endogenous. After laparoscopic hysteroscopic treatment, the blood loss (83 ± 32) ml, postoperative anal exhaust time (19.0 ± 7.6) h, postoperative vaginal bleeding time (6.2 ± 2.9) d, serum HCG decreased to normal Time (9.6 ± 3.0) d, discharge time (4.2 ± 1.8) d, no one complication occurred. Conclusions Hysteroscopy combined with cesarean section in pregnant women with minimally invasive gestational cesarean section has the advantages of rapid recovery after operation and definite clinical effect. It is an effective measure to retain organ reproductive function and is worthy of clinical promotion.