腹腔镜间断褥式内翻缝合法治疗Ⅱ型剖宫产瘢痕妊娠15例

摘要

Objective To investigate the efficacy and value of laparoscopic interrupted inverting mattress suture for type Ⅱcesarean scar pregnancy ( CSP ) . Methods A retrospective analysis was made on 15 cases of CSP treated with laparoscopic interrupted inverting mattress suture between September 2014 and November 2015.Interrupted mattress suture and ligation was conducted at the myometrium near the margin of scar pregnancy mass , with supplying arteries ligated simultaneously .Then interrupted inverting mattress suture was perfomed at weak parts at lower and upper boundary of the mass .Artificial negative pressure suction was carried out after the blockage of local blood supply . Results The surgery was completed smoothly in the 15 cases.No conversion to laparotomy was needed.The operation time was 40-110 min (mean, 55.0 ±27.3 min).The volume of bleeding was 10-90 ml (mean, 40.0 ±29.8 ml).Postoperative serum beta human chorionic promoting gonadotropin (β-hCG) significantly reduced by more than 50%on the 3rd day and returned to normal levels at (33.4 ±4.7) days after operation, with good uterine recovery.Fifteen patients were followed up for 2 -4 months.Ultrasonography at 1 month after operation showed normal size and morphology of the uterus .The myometrial thickness at the lower scar parts was 4-12 mm (median, 5 mm).The menstruation returned to normal, without irregular vaginal bleeding . Conclusion Laparoscopic interrupted inverting mattress suture for typeⅡCSP has satisfactory outcomes .%目的：腹腔镜间断褥式内翻缝合法在Ⅱ型剖宫产瘢痕妊娠（ cesarean scar pregnancy ，CSP）的应用效果及价值。方法2014年9月～2015年11月采用腹腔镜间断褥式内翻缝合法治疗15例Ⅱ型CSP，于瘢痕妊娠包块外缘子宫肌层处间断褥式缝扎，明显供血动脉分支一并缝扎，然后于包块上下边界的薄弱部位间断褥式内翻缝合，阻断瘢痕妊娠局部血供后行人工负压吸引术。结果15例手术顺利，无一例中转开腹。手术时间40～110 min，（55．0±27．3） min；出血量10～90 ml，（40．0±29．8）ml。术后3 d患者血β-hCG下降均＞50％，术后（33．4±4．7）d降至正常，子宫恢复好。15例随访2～4个月，术后1个月超声检查子宫大小形态恢复正常，下段瘢痕部位子宫肌层厚度4～12 mm（中位数5 mm），患者月经恢复正常，未见不规则阴道流血。结论腹腔镜下间断褥式内翻缝合法治疗Ⅱ型CSP效果满意。