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目的探讨介入化疗栓塞子宫动脉后行宫腹腔镜手术治疗子宫切口瘢痕妊娠的临床应用价值。方法回顾分析20例子宫切口瘢痕妊娠患者,术前根据病史及血人绒毛膜促性腺激素(HCG)及B超诊断为子宫切口瘢痕妊娠,其中12例为一型瘢痕妊娠,8例为二型瘢痕妊娠,在局部麻醉下行子宫动脉甲氨蝶呤+明胶海绵颗粒介入化疗栓塞术,术后3~7 d行手术治疗,一型瘢痕妊娠患者行腹腔镜监视下宫腔镜下清宫术,二型瘢痕妊娠患者行腹腔镜下妊娠组织清除术。结果 20例患者均成功清除瘢痕处妊娠组织,术中出血20~100 ml,术后血HCG均在30 d内降至正常。结论介入栓塞后行宫腹腔镜手术治疗子宫切口瘢痕妊娠安全有效,术前栓塞瘢痕处血供,降低了术中大出血风险,值得临床应用。
Objective To investigate the clinical value of hysteroscopic laparoscopic hysterectomy for uterine incision scar pregnancy after interventional chemotherapy. Methods Twenty cases of uterine incision scar pregnancy were retrospectively analyzed. Uterine incision scar pregnancy was diagnosed preoperatively according to their medical history, blood HCG and B ultrasound. Among them, 12 cases were type Ⅰ scar pregnancy and 8 cases were type Ⅱ Scar pregnancy, under local anesthesia uterine artery methotrexate + gelatin sponge particles interventional chemotherapy embolization, surgery 3 to 7 days after surgery, a type of scar pregnancy patients under laparoscopic hysteroscopic curettage, Type of scar pregnancy patients underwent laparoscopic removal of pregnancy. Results All the 20 patients were successful in removing the scar tissue. The intraoperative bleeding ranged from 20 to 100 ml. The postoperative HCG levels decreased to normal within 30 days. Conclusions Interventional laparoscopic hysterectomy for the treatment of uterine incision scar pregnancy safe and effective preoperative embolization scar blood supply, reducing the risk of intraoperative bleeding, it is worth clinical application.