提出一种腹腔镜手术前临时子宫动脉钳夹技术,以预防宫角异位妊娠的失血。
使用视频和静止图像逐步解释整个外科手术过程(加拿大工作队分类III)。
以大学为基础的医院。
一名37岁女性,闭经55天,β-hCG水平极高,达281,400mIU/mL。经阴道超声检查发现7厘米的肿块,有充足的血液供应,侵入了右子宫角周围的肌层。
获得了机构审查委员会和道德委员会的批准。盆腔粘连松解术后,腹膜后切开,双侧子宫动脉暴露。为了减少大出血的可能性,钛夹用于临时阻断双侧子宫动脉。腹腔镜检查显示肿块为深蓝色,与宫角妊娠的诊断一致。去除角膜损伤后,2-0Vicryl用于重建子宫。手术结束时,移除钛夹以逆转子宫血液供应。
手术持续了大约2个小时,估计失血量只有50毫升。患者完全康复,术后2天出院,没有任何进一步的出血或术后并发症。病理检查证实诊断为宫角妊娠。
一个月后,β-hCG水平降低至正常范围。术后6个月随访,超声检查显示子宫大小正常。
手术期间子宫动脉的暂时阻塞可以防止大量失血,特别是在困难的手术,如复杂子宫纤维瘤的子宫肌瘤切除术或腺肌瘤切除术。此外,这种技术对于紧急情况是可行的,包括剖宫产瘢痕妊娠的保守手术,也可以代替传统的子宫动脉栓塞术治疗宫角妊娠。
To present a technique of temporary uterine artery clamping before laparoscopic surgery for prevention of blood loss in cornual ectopic pregnancy.
Step-by-step explanation of the entire surgical procedure using video and still images (Canadian Task Force classification III).
Tertiary university-based hospital.
A 37-year-old woman who presented with amenorrhea of 55 days and extremely high β-hCG level of 281,400 mIU/mL. Transvaginal ultrasound examination revealed a 7 cm mass with ample blood supply invading the muscularis layer around the right uterine cornua.
Institutional Review Board and Ethics Committee approval was obtained. After pelvic adhesiolysis, retroperitoneum was dissected and the bilateral uterine arteries were exposed. To reduce the possibility of massive hemorrhage, titanium clips were used to temporarily block the bilateral uterine arteries. Laparoscopic inspection showed the mass as dark and blue, consistent with the diagnosis of cornual pregnancy. After removal of the cornual lesion, 2-0 Vicryl was used to reconstruct the uterine cornua. At the end of the surgery, the titanium clips were removed to reverse the uterine blood supply.
The surgery lasted for about 2 hours, with estimated blood loss of only 50 mL. The patient recovered completely and was discharged 2 days postoperatively, without any further bleeding or postoperative complications. The pathological examination confirmed the diagnosis of cornual pregnancy.
One month later, the β-hCG levels decreased to within normal range. At 6-month postoperative follow-up, ultrasound examination showed a normal size uterus.
Temporary blockage of the uterine artery during surgery could prevent heavy blood loss, especially in difficult surgeries such as myomectomy for complex uterus fibromas or adenomyomectomy. Moreover, this technique would be feasible for emergent cases, including conservative surgery for cesarean scar pregnancy, and could also replace traditional uterine artery embolization for treating cornual pregnancy.