剖宫产瘢痕妊娠的诊断与治疗进展

The Diagnosis and Treatment of Cesarean Scar Pregnancy

剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)是指妊娠囊种植在剖宫产术后子宫瘢痕部位,其外周被子宫肌层和纤维组织包围,是一种罕见的异位妊娠。其可以导致阴道大出血、子宫破裂、孕产妇生育能力丧失,甚至死亡。近年来,CSP的发病率有逐年上升的趋势,但发病机制尚不明确。因此,做好CSP的早诊断、早治疗显得尤为重要。超声检查能够辅助医务人员做到CSP的早诊断,但是尚缺乏统一的标准。而CSP的治疗,也尚未统一规范化。综述CSP的诊断与治疗进展。

Implantation of conception tissue within a cesarean section scar,named cesarean scar pregnancy（CSP）,is an extremely rare form of ectopic pregnancy with devastating complications,such as uterine rupture and intractable bleeding,which may also lead to other life-threatening complications such as the pregnancy advances,loss of subsequent fertility,or even maternal death. Recently,the diagnosis of CSP is increasing,which attributed to growing awareness,expanding use of early pregnancy transvaginal ultrasound and rising rates of caesarean delivery. While the mechanism which contributes to cesarean scar pregnancy is still unclear,and the most notable mechanism is that the blastocyst invades myometrium through a microscopic dehiscent tract,which is believed to develop from the trauma of a previous cesarean section or any other uterine surgery. Although ultrasonographic devices are used adequately for precise diagnosis,but there is still a lack of consensus concerning management strategies. Moreover,the optimal management of CSP is unclear and a variety of therapeutic strategies are used,without clear management consensus at this time. The current primary intervention is early interruption of the pregnancy. Both medical and surgical approaches to the management of CSP are reported. The article is a review of the diagnosis and treatment of cesarean scar pregnancy.