腹腔镜荧光引导检测子宫壁龛——下一步手术诊断和治疗

(1)背景：子宫壁龛是剖宫产史患者的常见病症。 虽然与子宫切开术的关系似乎很清楚，但确切的发病机制尚不完全清楚。 子宫壁龛很容易通过经阴道超声诊断。 它可能与痛经、出血性疾病、排尿困难和性交痛等症状有关。 子宫壁龛可能是疤痕妊娠的原因，这是一种罕见的异位妊娠形式，可能与严重的并发症有关；

(2) 方法：展示了一系列 9 例具有不同子宫生态位相关发现的病例，并讨论了回顾当前文献的诊断和治疗选择，并在一个案例中介绍了一种用于腹腔镜生态位检测的新型宫内 ICG；

(3)结果：大部分子宫壁相关症状和并发症可以通过微创方法治疗。 腹腔镜荧光引导生态位检测是可行的；

(4)结论：宫腔镜和腹腔镜技术可以治疗子宫壁龛相关症状和并发症。 荧光引导腹腔镜检查期间的宫内 ICG 应用可以轻松检测生态位。

腹腔镜荧光引导检测子宫壁龛——下一步手术诊断和治疗

宫内应用吲哚菁绿溶液后腹腔镜荧光引导观察子宫壁龛。

腹腔镜荧光引导检测子宫壁龛——下一步手术诊断和治疗

经阴道超声显示妊娠 6 周的利基妊娠。

腹腔镜荧光引导检测子宫壁龛——下一步手术诊断和治疗

利基妊娠（妊娠 7 周）的腹腔镜治疗。 (a) 子宫腔妊娠的腹腔镜视图； (b) 使用单极针腹腔镜切除子宫疤痕和利基妊娠； (c) 腹腔镜切除妊娠囊； (d) 子宫壁双层缝合后的腹腔镜视图。

腹腔镜荧光引导检测子宫壁龛——下一步手术诊断和治疗

症状性子宫壁龛妊娠的腹腔镜治疗。 (a) 壁龛切除后子宫颈的腹腔镜视图； (b) 子宫壁和腹膜双层缝合后的腹腔镜视图。

腹腔镜荧光引导检测子宫壁龛——下一步手术诊断和治疗

(a) 经阴道超声显示子宫壁龛； (b) 子宫腔的宫腔镜视图。

腹腔镜荧光引导检测子宫壁龛——下一步手术诊断和治疗

(a) 横向经阴道超声显示子宫前壁有一个大的峡部膨出； (b) 去腹膜和膀胱脱离后峡部膨出的腹腔镜视图； (c) 腹腔镜缝合——第一层； (d) 腹腔镜缝合——第二层。

腹腔镜荧光引导检测子宫壁龛——下一步手术诊断和治疗

切除后的标本。 (a) 峡部膨出的内部结构； (b) 有粘液的峡部膨出。

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