经阴式组织清除术治疗子宫疤痕妊娠的价值

摘要

Objective To explore the clinical value of translational debridement surgery in the treatment of cesar-ean scar pregnancy. Methods The clinical data of 32 cases with cesarean scar pregnancy diagnosed and treated in Peo-ple's Hospital of Hainan Province from October 2006 to October 2012 were retrospectively analyzed. Results All pa-tients had history of cesarean section, and were diagnosed by ultrasonograpy examination. Non-surgical group included 10 cases (pure MTX chemotherapy in 2 cases and uterine artery embolism in 8 cases), with the cure rate of 90.5%and in-cidence of adverse events of 42.3%. 37.2%of which were found with menstrual dripping phenomenon after postopera-tive recovery and 1 case was pregnant again. The remaining 22 cases were managed by surgical lesion resection (14 by transvaginal cesarean scar pregnancy debridement surgery and 8 by hysteroscopy and laparoscopy combined with sur-gery), and the cure rate was 100%, with no complications. Postoperative blood HCG decreased faster, and postopera-tive recovery period was shorter. Eight cases were pregnant again. Conclusion Transvaginal debridement surgery is a valuable, safe and reliable treatment for cesarean scar pregnancy with merits of shorter operative time and less bleed-ing, which is worthy of clinical application.%目的：探讨经阴式组织清除术治疗剖宫产后子宫疤痕妊娠的价值。方法回顾性分析我院2006年10月至2012年10月期间治疗的32例子宫疤痕妊娠患者的临床诊治资料。结果患者均有剖宫产史，经阴道彩超检查诊断。非手术组10例包括单纯MTX化疗2例及子宫动脉介入栓塞治疗8例，治愈率为90.5%，副反应发生率为42.3%，37.2%的患者出现术后月经恢复后淋漓不尽现象，1例患者再次妊娠；手术组行病灶切除术22例，包括经阴式手术14例，宫腹腔镜联合手术8例，治愈率为100%，无手术并发症，血HCG下降至正常时间短，月经恢复至正常时间短，8例再孕。结论经阴式组织清除术治疗子宫疤痕妊娠具有手术时间短、出血少、再孕率高、安全可靠等优势，值得推广应用。