Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi (SA), Italy,
Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
Gynecol Obstet Invest. 2021;86(1-2):55-62. doi: 10.1159/000510510. Epub 2020 Dec 10.
Ectopic pregnancy is the most common cause of mortality during the first trimester of pregnancy, and intrauterine ectopic pregnancies show significantly higher morbidity and mortality than extrauterine ones. Despite being less invasive, safety and effectiveness of the hysteroscopic treatment are still unclear. Moreover, such approach is not standardized. We aimed to evaluate safety and effectiveness of hysteroscopic intact removal of angular or cesarean section scar pregnancies, defining a novel and markedly less invasive hysteroscopic technique with a 5-mm Bettocchi hysteroscope or a 3.5-mm Versascope hysteroscope.
Medical records and video archives were reviewed for all the patients with angular or caesarean scar pregnancies treated with hysteroscopic intact removal technique from January 2000 to December 2018 at our Department. Success and complication rates were assessed.
Four patients with angular (n = 1) or cesarean scar pregnancy (n = 3) met inclusion criteria. Case #1 was treated with bipolar resectoscope, cases #2 and #3 with 5-mm Bettocchi hysteroscope, and case #4 with 3.5-mm Versascope hysteroscope. Cases #2-4 did not require cervical dilatation. Before hysteroscopic treatment, cases #2-4 underwent unsuccessful medical therapy with multiple-dose methotrexate. Hysteroscopic treatment success rate was 100%, while complication rate was 0%. All patients were treated with a novel technique: hysteroscopic intact removal of angular or cesarean scar pregnancies. Such technique was described step-by-step.
Hysteroscopic treatment of angular and cesarean scar pregnancies may be a safe and effective minimally invasive option. The novel technique of hysteroscopic intact removal technique may allow a markedly less invasive approach.
宫外孕是妊娠早期最常见的死亡原因，而子宫内异位妊娠的发病率和死亡率明显高于子宫外异位妊娠。尽管宫腔镜治疗的侵入性较小，但安全性和有效性仍不清楚。此外，这种方法还没有标准化。我们旨在评估宫腔镜完整切除角状或剖宫产瘢痕妊娠的安全性和有效性，定义一种新的、明显较少侵入性的宫腔镜技术，使用 5mm Bettocchi 宫腔镜或 3.5mm Versascope 宫腔镜。
回顾了 2000 年 1 月至 2018 年 12 月期间在我科接受宫腔镜完整切除技术治疗的所有角状或剖宫产瘢痕妊娠患者的病历和视频档案。评估了成功率和并发症发生率。
4 名角状（n=1）或剖宫产瘢痕妊娠（n=3）患者符合纳入标准。病例 1 采用双极电切镜治疗，病例 2、3 采用 5mm Bettocchi 宫腔镜治疗，病例 4 采用 3.5mm Versascope 宫腔镜治疗。病例 2-4 无需宫颈扩张。在宫腔镜治疗前，病例 2-4 接受了多次甲氨蝶呤药物治疗，但均不成功。宫腔镜治疗成功率为 100%，并发症发生率为 0%。所有患者均采用一种新的技术进行治疗：宫腔镜完整切除角状或剖宫产瘢痕妊娠。该技术分步骤进行了描述。
宫腔镜治疗角状和剖宫产瘢痕妊娠可能是一种安全有效的微创选择。宫腔镜完整切除技术的新方法可能允许采用明显较少侵入性的方法。
