宮、腹腔鏡聯合手術治療剖宮產切口妊娠的療效分析

摘要：目的 探討宮、腹腔鏡聯合手術治療剖宮產切口妊娠（CSP）的安全性、有效性及可行性。方法 選擇于2014年1月～2015年10月在我院住院的CSP患者50例分為3組，A組（20例）血HCG<10000 mIU/ml，采用宮、腹腔鏡手術治療；B（15例）組血HCG>10000 mIU/ml，先給予甲氨蝶呤肌注，待血HCG<10000 mIU/ml時再手術；C組（15例）血HCG>10000 mIU/ml，仍直接采用宮、腹腔鏡手術。對術中出血量、手術時間、住院時間、手術成功率等進行統計學分析。結果 三組患者均治愈出院，A、B組手術時間、出血量均明顯低于C組，成功率高于C組，差異有統計學意義（P<0.05）；B組住院時間明顯高于C組，但手術時間、出血量均低于C組，差異有統計學意義（P<0.05）。結論 對血HCG較低病例，或血β-HCG較高患者先采用甲氨蝶呤肌注降低血HCG后，再行宮、腹腔鏡手術治療CSP，是安全、有效、可行的治療方案，值得推廣。

關鍵詞：剖宮產切口妊娠；腹腔鏡；宮腔鏡；甲氨蝶呤

Clinical Analysis of Hysteroscopy Combined with Laparoscopy in the Treatment of Cesarean Section Incision Pregnancy

CHEN Zhi-gang

（Obstetrics and Gynecology Department，Mianyang Third People's Hospital，Mianyang 621000，Sichuan，China）

Abstract：Objective To evaluate the safety，feasibility and effectiveness of Laparoscopic assisted hysteroscopy operation on CSP patients.Methods 50 CSP patients from january 2014 to october 2015 in our hospital were divided into three Groups.Group A（20 cases）who were HCG<10000mIU/ml，were treated with Laparoscopic assisted hysteroscopy operation.Group B（15 cases）who were HCG>10000mIU/ml，were treated by Methotrexate before Laparoscopic assisted hysteroscopy operation.Group C（15 cases） who were HCG>10000mIU/ml，were direct treated with Laparoscopic assisted hysteroscopy operation.Results Three groups prtients were hospital cures.Group A and B bleeding volume and opration time were less than Group C，the success rate were higher than Group C（P<0.05）.The length of stay of Group B were longer than Group C，but bleeding volume and opration time were less than Group C（P<0.05）.Conclusion It is safety，feasibility and effectiveness to use Laparoscopic assisted hysteroscopy operation on CSP patients，which HCG is in low level，or treated by Methotrexate of HCG who is in high level patients.This treatment is worth of popularizing.

Key words：Cesarean scar pregnancy；Laparoscopic operation；Hysteroscopy；Methotrexate

剖宮產切口妊娠（caesarean scar pregnancy，CSP）是一種特殊部位的異位妊娠，在臨床上常被誤診為宮頸妊娠、難免流產或不全流產，在流產或清宮時可發生致命的大量出血，危及患者生命。目前對剖宮產切口妊娠的治療國際上尚無統一的治療方法。故選擇安全、有效、可行的治療方法可減少患者并發癥，減輕痛苦。腹腔鏡具有微創、術后恢復快、療效確切等優勢。對筆者所在醫院住院治療的CSP患者，采取宮腹腔鏡聯合手術治療，效果滿意，現報告如下。

1 資料與方法

1.1一般資料 選取于2014年1月～2015年10月在我院住院的CSP患者50例分為三組，三組患者在年齡、剖宮產次數、距上次剖宮產時間等基本情況比較，差異無統計學意義（P>0.05）。……