经阴道剖宫产瘢痕妊娠病灶切除术9例报告

摘要

[Summary] The paper reported 9 cases of external type cesarean scar pregnancy treated with transvaginal local lesion resection between January 2013 and March 2014 in this hospital .The surgical exposure was established by using vaginal tractors .The cervical front lip was pulled below outwards by using cervical clamp to expose the front vaginal fornix .Hemostatic water was injected into the cervix vaginal clearance (epinephrine 0.5 mg +NS 500 ml).The vaginal mucosa was opened at bladder cervix groove level for entering the bladder cervix clearance .The bladder was seperated upwards and to the side with fingers to expose uterine isthmus lesions . After cutting the thin muscle , the embryos and part of necrotic tissues were extracted for pathological examination .The incision scar around tissues were trimed and a drainage tube was placed in the uterine .A myometrium full-thickness continuous suture was performed with 1-0 absorbable sutures ( paying attention to avoid endometrial tissues ) , and the vaginal wall was continuously sutured with 1-0 absorbable thread .The drainage tube was removed 5 days after operation .The operations were successfully accomplished in all the 9 cases.The average operation time was 65 min (40-90 min), and the average blood lose was 60 ml (40-80 ml).Cervical tube adhesion occurred in 1 case, and no complications were observed in the remaining cases .The average hospitalization time was 7.5 days (5-10 days).The postoperative time of menstruous restoration was 28-40 days.We deem that transvaginal resection of cesarean scar pregnancy lesion is simple and deserves clinical popularization .%本文报道我院2013年1月～2014年3月经阴道行局部病灶切除术治疗外凸性剖宫产瘢痕妊娠9例。置阴道拉钩暴露，宫颈钳钳出宫颈前唇向外下方牵拉，暴露阴道前穹隆，宫颈阴道间隙内注入止血水（肾上腺素0．5 mg＋生理盐水500 ml稀释），膀胱宫颈沟水平切开阴道黏膜，进入膀胱宫颈间隙，用手指向上及两侧分离并推开膀胱，暴露宫颈峡部病灶部位，剪开菲薄的肌层后吸取胚胎及部分坏死组织送病理，修剪切口周边瘢痕组织，宫腔内置引流管1枚，术后5d取出。1号可吸收线行子宫肌层全层连续缝合（注意勿带内膜组织），阴道壁1号可吸收线行连续缝合。9例手术均获成功，平均手术时间65 min（40～90 min），平均出血量60 ml（40～80 ml）。平均住院时间7．5 d（5～10 d）。1例宫颈管粘连，余无并发症。术后月经恢复时间28～40 d。我们认为经阴道剖宫产瘢痕妊娠病灶切除术治疗剖宫产瘢痕妊娠，手术操作简单，值得临床推广应用。