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目的探讨经宫腔镜监视下吸宫术治疗早期内生型剖宫产瘢痕妊娠(CSP)的安全性和可行性。方法对妊娠≤7周,孕囊直径≤20mm,孕囊与膀胱壁间的子宫肌层厚度≥3.0mm,临床分型为内生型的10例CSP患者,进行宫腔镜监视下吸宫术,观察手术时间、术中出血量、刮除组织的病理检查结果、术后阴道流血天数、有无继发阴道大出血、吸宫后血β-HCG的下降至正常的天数、阴道彩超检查结果及复经时间。结果 10例CSP患者手术全部顺利完成,术中出血量为10～20ml;所有患者清宫组织病理检查均见绒毛组织;9例患者血β-HCG于清宫后14～28d降至正常;1例患者于清宫后第3周出现下腹部疼痛,瘢痕可疑破裂,遂急诊行腹腔镜下CSP病灶局部切除术。随访2～4个月,所有患者月经均恢复正常。结论对早期内生型的CSP患者,经术前的认真评估,经宫腔镜监视下吸宫术是安全可行的,但术后随诊应注意血β-HCG的下降情况,警惕妊娠组织残留,如果血β-HCG的下降不满意,应考虑及早注射MTX等药物。
Objective To investigate the safety and feasibility of hysteroscopic cesarean aspiration for treatment of early endocrine scar pregnancy (CSP). Methods Pregnancy ≤ 7 weeks, gestational sac diameter ≤ 20mm, between the gestational sac and the bladder wall thickness of the myometrium ≥ 3.0mm, clinical classification of endogenous 10 cases of CSP patients under hysteroscopic monitoring of suction aspiration , Observe the operation time, intraoperative blood loss, curettage histological examination results, postoperative vaginal bleeding days, with or without secondary vaginal bleeding, aspiration of blood β-HCG decreased to normal days, vaginal color Doppler ultrasound examination results and Time elapsed. Results The operation of 10 patients with CSP was successfully completed. The blood loss was 10 ~ 20ml in all 10 cases. Villous tissues were found in all the patients’ histopathological examination. The blood β-HCG in 9 cases was normal after 14 ~ In the third week after the Qing Dynasty, there was lower abdominal pain, scar suspicious rupture, then the emergency department underwent laparoscopic CSP focal resection. Follow-up 2 to 4 months, all patients with normal menstruation. Conclusion Early endocervical CSP patients, the careful assessment before surgery, hysteroscopic monitoring of suction aspiration is safe and feasible, but the postoperative follow-up should pay attention to the decline of blood β-HCG, vigilance of pregnancy tissue residues , If the blood β-HCG decline is not satisfied, should consider early injection of MTX and other drugs.