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目的探讨适合不同临床分型剖宫产瘢痕妊娠(CSP)患者的腹腔镜手术方式,为改善CSP治疗提供临床参考。方法将41例CSP患者分为瘢痕处宫腔内妊娠囊存活型(Ⅰ型)、瘢痕处肌层内妊娠囊型(Ⅱ型)和包块型或类滋养细胞型(Ⅲ型)。Ⅰ型患者主要采用腹腔镜下清宫术,Ⅱ型患者主要采用腹腔镜下双侧子宫动脉阻断+清宫术,Ⅲ型患者主要采用双侧子宫动脉阻断+瘢痕妊娠病灶切除术+子宫修补术。记录各型患者手术方式、手术时间、术中出血量;随访6月,了解患者恢复情况。结果Ⅰ型患者16例行清宫术,2例行动脉阻断术+清宫术;Ⅱ型患者共11例行动脉阻断术联合清宫术,2例患者行清宫术;Ⅲ型患者均行双侧子宫动脉阻断+瘢痕妊娠病灶切除术+子宫修补术;所有患者均无行全子宫切除术;手术时间和术中出血量比较来看,Ⅰ型患者手术时间最短、术中出血量最少,Ⅱ型患者手术时间和术中出血量次之,Ⅲ型患者手术时间最长、术中出血量最多。结论腹腔镜治疗CSP临床疗效显著,不同CSP分型患者宜采取不同腹腔镜手术方式。
Objective To investigate the laparoscopic operation for patients with different clinical classification of cesarean scar pregnancy (CSP) and to provide clinical reference for the improvement of CSP. Methods Forty - one CSP patients were divided into three groups: the intrauterine gestational sac type (Ⅰ), the intracapsular pregnancy type Ⅱ (type Ⅱ) and the trophoblastic type Ⅲ (type Ⅲ). Type I patients with laparoscopic radical mastectomy, type II patients mainly with laparoscopic bilateral uterine artery occlusion + curettage, type III patients with bilateral uterine artery occlusion + scar pregnancy resection + uterine repair . Record various types of patients surgical methods, operation time, intraoperative blood loss; follow-up in June, to understand the patient recovery. Results In type Ⅰ, 16 patients underwent radical mastectomy and 2 patients underwent arterial occlusion and radical mastectomy. In type Ⅱ, 11 patients underwent arterial occlusion combined with radical mastectomy and in 2 patients undergoing radical mastectomy. Type Ⅲ patients underwent bilateral posterior Uterine artery occlusion + cesarean section excision + uterine repair; all patients without line hysterectomy; operation time and intraoperative bleeding comparison, type I patients the shortest operation time, the least amount of blood loss, Ⅱ Type operation time and intraoperative blood loss, followed by type III patients the longest operation time, intraoperative blood loss the most. Conclusion Laparoscopic treatment of CSP significant clinical effect, different CSP patients should take different laparoscopic surgery.