Abstract: ObjectiveTo investigate the value of laparoscopic surgery and hysteroscopic surgery in the treatment of cesarean scar pregnancy(CSP).MethodsThe clinical data of 65 women diagnosed CSP admitted from January 2013 to December 2015 were analyzed retrospectively, including 30 cases treated by laparoscopy (as laproscopy group) and 35 cases treated by hysteroscopy (as hysteroscopy group). The intraoperative bleeding volume, operative time, hospitalization days, postoperative complications, the restored duration of β-hCG levels, operation expenses, menstrual recovery time and uterus scar 3 months after the surgery were compared between two groups.ResultsAll 30 patients of laparoscopy group were successfully completed laparoscopy, and 33 cases of hysteroscopy group were accomplished hysteroscopy except 2 patients conversed to laparoscopy due to bigger lesion, massive hemorrhage and fuzzy operation field. Compared to hysteroscopy group, the bleeding volume was larger, the operation time and hospital stays were longer, the medical cost was higher and the scar size of lower uterine segment was smaller in laparoscopy group, and the differences were statistically between two groups (P<0.01). There was no statistical difference in the restored duration of β-hCG level between two group (P>0.05). All cases were followed up for 3 months and resumed menstruation in 2 months.ConclusionsBoth laparoscopic local lesion resection of uterine combined uterus neoplasty and hysteroscopic tissue resection of cicatricial uterine pregnancy can achieve termination of pregnancy effectively with advantages of mini-invasion. Laparoscopy can repaired the scar defect, retain reproductive function with broad indication, while hysteroscopy revealed mini-trauma, shorter hospitalization time, low cost and quicker recovery, but it is not beneficial for re-pregnancy due to the bigger intrauterine scar formation.
李翠芬，刘燕燕，霍炽文. 腹腔镜与宫腔镜治疗子宫疤痕妊娠临床疗效分析[J]. 中国现代手术学杂志, 2017, 21(6): 458-463.
LI Cui-fen. Control Study on Laparoscopy and Hysteroscopy for Cesarean Scar Pregnancy. Chinese Journal of Modern Operative Surgery, 2017, 21(6): 458-463.
[1] Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management[J]. Obstet Gynecol, 2006, 107(6):1373-1381.[2] Kutuk MS, Uysal G, Dolanbay M, et al. Successful medical treatment of cesarean scar ectopic pregnancies with systemic multidose methotrexate: single-center experience[J]. J Obstet Gynaecol Res, 2014, 40(6):1700-1706. doi: 10.1111/jog.12414.[3] Matyszkiewicz A, Jach R, Nocuń A, et al. Cesarean scar pregnancy[J]. Ginekol Pol, 2015, 86(10):791-798.[4] Yazicioglu F, G?kdogan A, Kelekci S, et al. Incomplete healing of the uterine incision after caesarean section: Is it preventable?[J]. Eur J Obstet Gynecol Reprod Biol, 2006, 124(1):32-36.[5] Ofili-Yebovi D, Ben-Nagi J, Sawyer E, et al. Deficient lower-segment cesarean section scars: prevalence and risk factors[J]. Ultrasound Obstet Gynecol, 2008, 31(1):72-77.[6] 王丽娟． 瘢痕妊娠的不同处理方案的不同结局[J]． 中国伤残医学，2013，21(6)：174-175．[7] Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar[J]. Ultrasound Obstet Gynecol, 2000, 16(6):592-593.[8] 中华医学会计划生育学分会. 剖宫产瘢痕妊娠诊断与治疗共识[J]. 中华医学杂志,2012,92(25):1731-1733.[9] 王海燕, 王红, 许芙蓉. 30例外生型子宫切口疤痕妊娠的临床探讨[J]. 实用临床医药杂志,2017,21(9),207-208.[10] 林经萍, 盛晓滨. 32例剖宫产子宫切口疤痕妊娠的临床分析[J]. 齐齐哈尔医学院学报,2017,38(5),529-530.[11] Robinson JK, Dayal MB, Gindoff P, et al. A novel surgical treatment for cesarean scar pregnancy: laparoscopically assisted operative hysteroscopy[J]. Fertil Steril, 2009, 92(4):1497.e13-6. doi: 10.1016/j.fertnstert.2009.07.996.[12] Calì G, Timor-Trisch IE, Palacios-Jaraquemada J, et al. Outcome of cesarean scar pregnancy: a systematic review and meta-analysis[J]. Ultrasound Obstet Gynecol, 2017, doi: 10.1002/uog.17568.[13] Liu G, Wu J, Cao J, et al. Comparison of three treatment strategies for cesarean scar pregnancy[J]. Arch Gynecol Obstet, 2017, 296(2):383-389. doi: 10.1007/s00404-017-4426-5.[14] Wang HY, Zhang J, Li YN, et al. Laparoscopic management or laparoscopy combined with transvaginal management of type II cesarean scar pregnancy[J]. JSLS, 2013, 17(2):263-272. doi: 10.4293/108680813X13654754535197.[15] 蒋清清, 于鹏, 谢红斌. 宫腹腔镜联合手术治疗剖宫产子宫切口瘢痕缺陷[J]. 中国内镜杂志, 2016,22(1): 83-85.[16] 李武, 吕雯. 宫腔镜引导取胚术治疗剖宫产瘢痕妊娠[J]. 中国内镜杂志, 2016, 22(03) 95-97.[17] Pan Y, Liu MB. The value of hysteroscopic management of cesarean scar pregnancy: a report of 44 cases[J]. Taiwan J Obstet Gynecol, 2017, 56(2):139-142. doi: 10.1016/j.tjog.2016.06.020.[18] Chen ZY, Zhao L, Nusilati A, et al. Clinical comparative analysis of surgical resection of the pregnancy by hysterotomy and hysterectomy for cesarean scar pregnancy[J]. Zhonghua Fu Chan Ke Za Zhi, 2017, 52(2):98-102. doi: 10.3760/cma.j.issn.0529-567X.2017.02.006.
2017, Vol. 21 
