剖宫产切口妊娠及胎盘植入的诊疗现状

The Diagnosis and Treatment Current Situation of Cesarean Section Pregnancy and Placenta Accreta

剖宫产切口妊娠(cesarean section pregnancy,CSP)及胎盘植入(placenta accreta)是剖宫产术后远期并发症之一,若诊断不明确、不及时,可发生子宫大出血、子宫破裂,严重者会危及母亲及胎儿生命。经阴道超声(transvaginal ultrasonography)是目前诊断CSP的首选辅助诊断方法,MRI对中晚孕的CSP是否有胎盘植入时优于超声,可作为补充。对于早孕期CSP的治疗及管理目前尚存在争论,一些学者的观点是:为了孕妇能够保留子宫且不危及生命安全,应在早期诊断明确后立即终止妊娠。方法包括药物治疗、清宫术、宫腔镜手术、经阴道子宫切口妊娠病灶清除术联合子宫肌壁修补术、子宫动脉栓塞化疗或子宫动脉栓塞术、全子宫切除术等。国外一些学者认为对于CSP的早期干预不一定有好的疗效。对CSP的治疗及管理仍在不断总结及探索中。

Cesarean section pregnancy（CSP） and placenta accreta are one of the long-term complications after cesarean section. If diagnosis is not accurate and prompt, the likelihood of hemorrhage and uterus rupture is high. Even maternal and fetus are endangered in severe case. Transvaginal ultrasonography is best adjuncts to assist diagnosis, MRI is superior toultrsonography in the diagnosis of placenta accreta in midtrimester and third trimester. MRI can be supplement. Treatment and management of CSP in first trimester was still discussed. According to some scholars, Abortion should be performed as soon as the diagnosis is established for the maternal safety and conservation of uterus. Therapy consist of medicine, curettage, hysteroscopic, transvaginal removal of CSP lesion combine uterine wall repair, arterial embolization chemotherapy（UAEC） or uterine arterial embolization（UAE）, hysterectomy et al. According to some foreign scholars, early intervention to CSP is not always associate with better outcomes. Treatment and management of CSP are still summarized and explored continuously.