剖宫产术后子宫瘢痕妊娠的诊断及治疗进展

Cesarean Scar Pregnancy:a Review of Literatures

剖宫产术后子宫瘢痕妊娠是一种少见的异位妊娠,但随着剖宫产率的上升,近年来有关子宫瘢痕妊娠的临床报道越来越多。该病发病机制尚不明确,现认为其与子宫内膜损伤有关。临床症状多表现为停经后阴道出血,有时伴腹痛,常需借助阴道超声检查确诊。该病若治疗不及时可引起阴道大出血甚至危及生命,一旦确诊需立即终止妊娠。目前对该病的治疗尚未形成统一规范的标准,治疗方法包括甲氨蝶呤(Methotrexate,MTX)治疗、刮宫术、子宫动脉栓塞术联合刮宫术、宫腔镜手术、腹腔镜下病灶切除术及子宫切除术等。

Cesarean scar pregnancy is a rare special type of ectopic pregnancy.With the rising of cesarean section rates in recent years,more and more cases of uterine scar pregnancy were reported.The pathogenesis remains unclear,but is thought to be related with endometrial injury.Postmenopausal vaginal bleeding is the most common symptom,sometimes accompanied by abdominal pain.Transvaginal ultrasound is now the primary method of diagnosis.The malpractice could lead to serious hemorrhea.Pregnancy should be immediately terminated once the diagnosis of cesarean scar pregnancy is made.Standard treatment has not been uniformed.There are several therapys,such as Methotrexate,dilatation and curettage,uterine artery embolization combined dilatation and curettage,hysteroscopy,laparoscopy and hysterectomy.