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目的:探讨经阴道剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)病灶清除术的临床应用价值。方法:某院2012年1月-2014年11月共收治CSP患者20例,停经时间43~65 d。经阴道三维多普勒超声显示剖宫产原切口处妊娠孕囊样包块最大直径10~39 mm,其中5例探及心管搏动。均经阴道行病灶清除术及子宫修补缝合术,局部单次注射甲氨蝶呤(MTX)50mg。结果:20例均手术成功,无并发症,术后复查B超均提示子宫前壁下段剖宫产切口瘢痕部位包块消失,血β-hCG恢复正常时间15~28 d,术后患者月经均恢复正常。结论:经阴道瘢痕病灶清除及修补缝合术联合局部MTX单次注射,可以完整清除病灶,手术操作微创、治疗效果好、并发症少。
Objective: To investigate the clinical value of cesarean scar pregnancy (CSP) debridement by vaginal cesarean section. Methods: A hospital from January 2012 to November 2014 were treated 20 cases of CSP patients, menopause time 43 ~ 65 days. Transvaginal three-dimensional Doppler ultrasound showed cesarean section incision pregnancy gestational sac mass of the largest diameter of 10 ~ 39 mm, of which 5 exploration and cardiac beating. All patients underwent vaginal debridement and uterine repair suture, and local single injection of methotrexate (MTX) 50mg. Results: All the 20 cases were operated successfully and no complications were found. The postoperative B-scan showed that the cesarean section in the anterior segment of the anterior uterus disappeared and the blood β-hCG returned to normal within 15-28 days. Back to normal. Conclusion: Vaginal scar sclerosis and repair suture combined with local MTX single injection can completely remove the lesion, minimally invasive surgery, the treatment effect is good, with fewer complications.