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目的总结宫腔镜治疗剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)失败的经验教训,探讨宫腔镜治疗剖宫产瘢痕妊娠的最佳适应证。方法 2014年3月至2016年12月采用宫腔镜下妊娠病灶切除术治疗CSP 43例,其中Ⅰ型25例,Ⅱ型16例,Ⅲ型2例。共失败7例(Ⅱ型5例,Ⅲ型2例),其中4例术中急症行子宫动脉栓塞术,其后行清宫术;2例转行腹腔镜下妊娠病灶清除术;1例转行经阴道妊娠病灶清除术。结果 7例患者均成功清除病灶,保留子宫。术后1个月血β-h CG均降至正常,26~53 d月经复潮。结论宫腔镜下妊娠病灶清除术适用于Ⅰ型和部分Ⅱ型瘢痕妊娠。术前全面评估,备好相应预案可以避免因宫腔镜手术选择不当造成的大出血,避免手术失败,减少患者损失,提高宫腔镜手术的成功率。
Objective To summarize the experiences and lessons of hysteroscopy in the treatment of cesarean scar pregnancy (CSP) and to discuss the best indications of hysteroscopic cesarean scar pregnancy. Methods From March 2014 to December 2016, 43 cases of CSP underwent hysteroscopic resection of pregnancy, of which 25 cases were type Ⅰ, 16 cases type Ⅱ and 2 cases type Ⅲ. A total of 7 cases failed (5 cases of type Ⅱ and 2 cases of type Ⅲ), of which 4 cases underwent emergency surgery with uterine arterial embolization followed by radical hysteroscopy, 2 cases underwent laparoscopic gestation and 1 case underwent vaginal transvaginal Pregnancy debridement. Results All 7 patients were successful in removing the lesion and retaining the uterus. The level of β-h CG decreased to normal one month after operation, and resumed tidal volume from 26 to 53 days. Conclusion hysteroscopic removal of pregnancy lesions for type Ⅰ and type Ⅱ scar pregnancy. Preoperative comprehensive assessment, prepared the corresponding plan to avoid due to improper selection of hysteroscopic surgery caused by bleeding, to avoid surgery failure, reduce patient losses and improve the success rate of hysteroscopic surgery.