Qian Zhi-Da, Weng Yue, Du Yong-Jiang, Wang Chun-Fen, Huang Li-Li
Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China.
Maternal and Child Health Institute of Lin'an City, 25 Jiangnan Road, Lin'an, Zhejiang Province, 311300, People's Republic of China.
BMC Pregnancy Childbirth. 2017 Jul 1;17(1):208. doi: 10.1186/s12884-017-1395-4.
Caesarean scar pregnancy (CSP) is a late serious complication of caesarean section. The incidence of CSP has increased worldwide in recent years. Early diagnosis and prompt therapy are crucial to avoid catastrophic complications. There are various strategies for CSP treatment, but there is no consensus on the best management for CSP. Dilation and curettage (D&C) and hysteroscopy are common and effective treatments with their advantages and disadvantages. No in-depth study of the clinical effects of hysteroscopic management of CSP after D&C treatment failure has been conducted. The purpose of this study is to evaluate the effectiveness and safety of hysteroscopic removal of residual CSP tissue (persistent CSP) as a rescue after failed D&C management.
This is a retrospective clinical research study. Forty-five patients underwent operative hysteroscopy to remove the residual gestational tissue in the caesarean scar after failed D&C treatment. The clinical characteristics and outcomes of hysteroscopic surgeries of 45 CSP cases were investigated. All data analyses were conducted with SPSS 17.0.
Forty-three CSP cases after unsuccessful curettage treatment were successfully treated by operative hysteroscopy. The estimated intraoperative blood loss was 20.00 (10.00-500.00) mL, the hysteroscopic operating time was 20.00 (15.00-45.00) min, the decline of serum β-hCG the day after surgery was 71.91 ± 14.05%, the total hospitalisation time was 7.87 ± 2.26 days, the medical cost was 13,682.71 ± 3553.77 China Yuan (CNY), the time of bleeding after surgery was 7.42 ± 2.48 days, and the time of serum β-hCG resolution after surgery was 13.84 ± 9.83 days. Follow-up after discharge demonstrated that there were no severe complications for any patients.
Hysteroscopy therapy could treat persistent CSP effectively and safely after curettage treatment failure. Therapy should be individualised, and the risks and cost of the hysteroscopy procedure and anaesthesia must be considered and fully discussed with the patients before surgery.
剖宫产瘢痕妊娠（CSP）是剖宫产术后一种严重的晚期并发症。近年来，CSP在全球范围内的发病率呈上升趋势。早期诊断和及时治疗对于避免灾难性并发症至关重要。CSP的治疗有多种策略，但对于CSP的最佳管理尚无共识。刮宫术（D&C）和宫腔镜检查是常见且有效的治疗方法，但各有优缺点。目前尚未对刮宫术治疗失败后宫腔镜管理CSP的临床效果进行深入研究。本研究的目的是评估在刮宫术管理失败后，宫腔镜切除残留CSP组织（持续性CSP）作为补救措施的有效性和安全性。
这是一项回顾性临床研究。45例患者在刮宫术治疗失败后接受了宫腔镜手术以切除剖宫产瘢痕中的残留妊娠组织。对45例CSP病例的宫腔镜手术临床特征和结果进行了调查。所有数据分析均使用SPSS 17.0进行。
43例刮宫术治疗失败后的CSP病例通过宫腔镜手术成功治疗。估计术中出血量为20.00（10.00 - 500.00）mL，宫腔镜手术时间为20.00（15.00 - 45.00）分钟，术后第1天血清β - hCG下降71.91 ± 14.05%，总住院时间为7.87 ± 2.26天，医疗费用为13,682.71 ± 3553.77元人民币（CNY），术后出血时间为7.42 ± 2.48天，术后血清β - hCG恢复正常时间为13.84 ± 9.83天。出院后随访显示，所有患者均无严重并发症。
刮宫术治疗失败后，宫腔镜治疗可有效、安全地治疗持续性CSP。治疗应个体化，术前必须考虑宫腔镜手术及麻醉的风险和费用，并与患者充分讨论。
