宫腔镜组织切除系统治疗输卵管间质部妊娠的可行性及安全性探索

Feasibility and safety of hysteroscopic tissue removal system in treatment of interstitial ectopic pregnancy

摘要:

目的 探讨宫腔镜组织切除系统在输卵管间质部妊娠中治疗的可行性及安全性。方法 收集2019年4月至2022年4月江西省妇幼保健院妇科收治的采用宫腔镜组织切除系统治疗的16例未破裂型输卵管间质部妊娠患者的临床资料，回顾性分析患者的术前血β-人绒毛膜促性腺激素（beta-human chorionic gonadotropin，β-HCG）、B超情况、手术时间、术中出血量及术后血β-HCG正常时间等。结果 16例未破裂型输卵管间质部妊娠患者术前血β-HCG值为830~31 153 mIU/mL，平均（8 643.561±1 752.000） mIU/mL，B超下妊娠物最大为33 cm×28 cm，最小为11 cm×10 cm。均在检查镜下明确诊断为输卵管间质部妊娠，使用宫腔镜组织切除系统行间质部妊娠病灶清除术，其中2例中转腹腔镜，平均手术时间为34（20，92） min，平均术中出血量为46.6（10，250） mL，术程顺利，无明显并发症。术后平均住院时间2 d，血β-HCG恢复正常时间为（22.00±5.11） d，术后1个月复查B超均未见妊娠组织残留，术后半年随访过程中共5例患者成功受孕。结论 宫腔镜组织切除系统在未破裂型输卵管间质部妊娠治疗中可保留器官完整性。

Abstract:

Objective To investigate the feasibility and safety of hysteroscopic tissue removal system in the treatment of interstitial ectopic pregnancy.Methods Related clinical data were collected from 16 patients with unruptured interstitial ectopic pregnancy who were admitted to Department of Gynecology，Jiangxi Maternal and Child Health Hospital，from April 2019 to April 2022 and were treated by the hysteroscopic tissue resection system，and a preoperative analysis was performed for preoperative blood β-human chorionic gonadotropin（β-HCG），ultrasound findings，time of operation，intraoperative blood loss，and time for blood β-HCG to return to normal after surgery.Results The 16 patients with unruptured interstitial ectopic pregnancy had a preoperative blood β-HCG level of 830-31 153 mIU/mL，with a mean value of （8 643.561±1 752.000） mIU/mL，and pregnancy tissue on ultrasound had a maximum size of 33 cm×28 cm and a minimum size of 11 cm×10 cm. All patients had a confirmed diagnosis of interstitial ectopic pregnancy after microscopic examination，and hysteroscopic tissue resection system was used to remove the lesions of interstitial pregnancy，among whom 2 patients were converted to laparoscopy. The mean time of operation was 34（20，92） minutes，and the mean volume of intraoperative blood loss was 46.6（10，250） mL. The surgical process was smooth with no obvious complications. The patients had a mean hospital stay of 2 days and a time of （22.00±5.11） days for blood β-HCG to return to normal after surgery. Ultrasound examination at 1 month after surgery showed no residue of pregnancy tissue，and 5 patients became pregnant successfully during follow-up for half a year.Conclusion The hysteroscopic tissue resection system can preserve organ integrity in the treatment of unruptured interstitial ectopic pregnancy.