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目的探讨宫腔镜电切术(TCRPR)用于治疗胎盘残留的临床价值。方法自2003年3月至2006年4月间,实施 TCRPR 14例,其中足月产后胎盘残留3例,晚期流产8例,病理妊娠中期引产3例。血清人绒毛膜促性腺激素β亚单位(β-hCG)>80 U/L 者,给予米非司酮25 mg 口服,每日3次,同时每隔3 d 给予米索前列醇600μg口服,共3次,每周复查β-hCG 和 B 超;β-hCG>150 U/L者,给予甲氨蝶呤深部肌内注射,剂量为1 mg/m~2。采用电切(双极汽化电切)+钳夹交替的方法,术毕宫腔内置圆形宫内节育器,术后给予戊酸雌二醇1～2 mg/d,从术后3～5 d 开始服用,21 d 为1个疗程,最后5 d 加服醋酸甲羟孕酮10 mg/d,治疗2～4个疗程。结果在 B 超严密监护下,14例TCRPR 均顺利完成,无一例出现并发症。术后随访6个月～2年,所有患者月经基本均恢复正常,其中有3例分别于术后4、6和7个月时妊娠并均已顺利分娩。结论 TCRPR 治疗胎盘残留具有创伤小、见效快、并发症少的特点。
Objective To investigate the clinical value of hysteroscopic electrotomy (TCRPR) in the treatment of placental residue. Methods From March 2003 to April 2006, 14 patients underwent TCRPR, including 3 cases of residual placenta after full-term pregnancy, 8 cases of late abortion and 3 cases of induced abortion in the middle of pathological pregnancy. Serum human chorionic gonadotropin beta subunit (β-hCG)> 80 U / L, given mifepristone 25 mg orally three times a day, while every 3 d to give misoprostol 600μg orally, a total of 3 times weekly review of β-hCG and B; β-hCG> 150 U / L were given intramuscular injection of methotrexate deep, the dose of 1 mg / m ~ 2. The method of electrosurgery (bipolar vaporization) and the clamp alternation method was adopted. The intrauterine device was intrauterine circular intrauterine device, and the administration of estradiol valerate 1 ~ 2 mg / d postoperatively from 3 to 5 d began to take, 21 d for a course of treatment, the last 5 d plus medroxyprogesterone acetate 10 mg / d, treatment of 2 to 4 courses. Results Under the supervision of B-ultrasonography, 14 cases of TCRPR were successfully completed, no case of complications. The patients were followed up for 6 months to 2 years. All patients had normal menstruation, and 3 of them had gestational birth at 4, 6 and 7 months after operation, respectively. Conclusion TCRPR treatment of placental residue with less trauma, quick, fewer complications.