Wang Guangwei, Liu Xiaofei, Sa Rina, Wang Dandan, Yang Qing
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China.
Email:
Zhonghua Fu Chan Ke Za Zhi. 2014 Jan;49(1):6-9.
To investigate the safety and feasibility of laparoscopic removal of exogenous caesarean scar pregnancy (CSP).
From January 2009 to May 2011, 71 patients with CSP treated in Shengjing Hospital of China Medical University were studied retrospectively. Thirty-nine patients were treated with hysteroscopic excision of CSP, while 32 patients were treated with laparoscopic surgery. The following clinical parameters were compared, including intraoperative blood loss, quantity of postoperative uterine drainage, postoperative hospital days, the time for the mass absorption and the return of β-hCG to normal were studied.
Two cases in the hysteroscopic group were transformed to abdominal surgery because of introperative bloody loss, the 37 cases underwent hysteroscopic surgery successfully with the ultrasound supervision and guidance.Laparoscopic surgery were successfully completed in all 32 cases.In hysteroscopic group, the operation time, the time for the return of serum β-hCG to normal, postoperative uterine drainage volume and the postoperative hospital stay were (44 ± 18) minutes, (27 ± 5) days, (38 ± 12) ml, (3.8 ± 0.7) days.While, in laparoscopic group, they were (100 ± 21) minutes, (17 ± 4) days, (19 ± 6) ml, (3.5 ± 0.6) days, respectively, the differences reached statistically significant (all P < 0.05). But the amount of intraoperative bleeding were was (113 ± 63) ml in hysteroscopic group and (109 ± 59) ml in laparoscopic group, the difference was not statistically significant (P > 0.05). The duration of absorption of mass were (88 ± 17) days in hysteroscopic group.In laparoscopic group, the mass were completely removed.
Laparoscopic exicion of CSP could be suitable in treatment of exogenous CSP which offers advantages including prompt recovery, blood loss and hospital stays. This management could repair the uterine scars, reduce the reoccurring risk and conservate the fertility potential.
探讨腹腔镜下切除外源性剖宫产瘢痕妊娠（CSP）的安全性及可行性。
回顾性分析2009年1月至2011年5月在中国医科大学附属盛京医院接受治疗的71例CSP患者。39例患者接受宫腔镜下CSP切除术，32例患者接受腹腔镜手术。比较以下临床参数，包括术中出血量、术后子宫引流量、术后住院天数、包块吸收时间以及β-hCG恢复正常的时间。
宫腔镜组有2例因术中出血转为开腹手术，37例在超声监测和引导下成功完成宫腔镜手术。32例腹腔镜手术均成功完成。宫腔镜组手术时间、血清β-hCG恢复正常时间、术后子宫引流量及术后住院时间分别为（44±18）分钟、（27±5）天、（38±12）毫升、（3.8±0.7）天。而腹腔镜组分别为（100±21）分钟、（17±4）天、（19±6）毫升、（3.5±0.6）天，差异均有统计学意义（均P<0.05）。但宫腔镜组术中出血量为（113±63）毫升，腹腔镜组为（109±59）毫升，差异无统计学意义（P>0.05）。宫腔镜组包块吸收时间为（88±17）天。腹腔镜组包块被完全切除。
腹腔镜切除CSP适用于外源性CSP的治疗，具有恢复快、出血少、住院时间短等优点。这种治疗方法可以修复子宫瘢痕，降低复发风险并保留生育潜能。
