Department of Obstetrics and Gynecology, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
Department of Obstetrics and Gynecology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey.
J Minim Invasive Gynecol. 2018 May-Jun;25(4):582. doi: 10.1016/j.jmig.2017.10.010. Epub 2017 Oct 13.
Laparoscopic excision of a scar pregnancy and isthmocele repair with a barbed suture.
A step-by-step explanation of the laparoscopic excision technique of a scar pregnancy and isthmocele repair.
Cesarean scar pregnancy occurs as a result of attachment of the products of conception to the uterine scar [1-3]. In the present case, a 34-year-old, gravida 4, para 1 patient with a history of 1 miscarriage and 1 ectopic pregnancy was diagnosed with type 2 cesarean scar pregnancy at 7 weeks of gestation. Dilation and curretage was performed at the 8th week of gestation to terminate the pregnancy. On ultrasonography performed 1 month later, placental material underlying the isthmocele was observed. Her beta human chorionic gonadotropin level was 13 836 mIU/mL. She was followed up for 1.5 months until the beta human chorionic gonadotropin levels were negative. However, the mass underneath the scar had grown larger, measuring up to 5 × 6 cm. Laparoscopy was performed because the patient reported vaginal spotting and pelvic pain. The incision was sutured with a synthetic absorbable unidirectional barbed suture (Stratafix Knotless Tissue Control Device; Ethicon Inc., Somerville, NJ). No residual scar defect was visible on follow-up ultrasonography 1 week and 1 month after surgery.
Barbed sutures ease the repair of uterine scar defects and can provide ideal reapproximation of thick myometrial tissue. Laparoscopic treatment of a scar pregnancy and isthmocele repair are effective and safe modes of treatment.
经腹腔镜切除瘢痕妊娠并用带刺缝线修复峡部。
腹腔镜切除瘢痕妊娠并用带刺缝线修复峡部的分步说明。
剖宫产瘢痕妊娠是由于妊娠产物附着在子宫瘢痕上引起的[1-3]。在本例中，一名 34 岁、经产妇 4 次、剖宫产 1 次、有 1 次流产和 1 次宫外孕病史的患者，在妊娠 7 周时被诊断为 2 型剖宫产瘢痕妊娠。第 8 周进行了扩张和刮宫以终止妊娠。1 个月后超声检查发现峡部下方有胎盘组织。她的β人绒毛膜促性腺激素水平为 13836 mIU/ml。她随访了 1.5 个月，直到β人绒毛膜促性腺激素水平转为阴性。然而，疤痕下方的肿块已经增大，大小达到 5×6cm。由于患者报告阴道点状出血和盆腔疼痛，进行了腹腔镜检查。切口用合成可吸收单向带刺缝线（Stratafix 无结组织控制装置；Ethicon Inc.，Somerville，NJ）缝合。手术后 1 周和 1 个月的随访超声检查未见残留的疤痕缺陷。
带刺缝线便于修复子宫疤痕缺陷，并能为厚的子宫肌组织提供理想的重新接近。腹腔镜治疗瘢痕妊娠和峡部修复是有效和安全的治疗方法。
