复发性剖宫产瘢痕妊娠的诊断及治疗

Recurrent cesarean scar pregnancy: diagnosis,treatment and prognosis

目的：总结分析复发性剖宫产瘢痕妊娠（RCSP）的临床表现、诊断、治疗及预后等,从而为临床诊治提供参考。方法：利用Pub Med数据库、万方数据库及中国期刊全文数据库检索关于RCSP报道的所有文献。通过阅读全文,总结分析RCSP的临床表现及诊断方法,重点探讨其治疗方法及预后。结果：共收集RCSP患者21例,其中自然妊娠19例。初次CSP治疗后至再次CSP的时间间隔6~64月,其中13例时间间隔小于12月。RCSP的治疗方案种类较多,但与初次CSP基本相同。16例患者采用与初次CSP时相同的治疗方法。两次治疗方案中均包含有UAE的9例患者中,4例再次手术时因子宫动脉闭锁,无法完成预期手术。患者均治疗成功并保留了子宫。结论：CSP患者治疗后再次妊娠时发生RCSP的几率将明显升高。RCSP的临床表现与超声诊断标准与CSP基本相同。RCSP治疗方案的选择需综合考虑患者前次CSP时的治疗方法等,尤其是拟再次选用UAE者。剖宫产子宫瘢痕的切除并不能防止RCSP发生。

Objective： To provide reference for the diagnosis and treatment of recurrent cesarean scar pregnancy（ RCSP）,we conducted a review on all of the reported cases in English and Chinese literatures by summarizing their clinical manifestation,diagnosis,management and prognosis. Methods： All literatures on RCSP were retrieved by searching in the Pub Med,CNKI and Wanfang databases and tracking reference of all the searched literatures. By reading all the full text carefully and thoroughly,summarized the clinical manifestations and diagnostic methods of RCSP,especially discussed the treatment and prognosis. Results： A total of 21 patients with HCSP were collected,including 19 cases with spontaneous pregnancy. The interval between previous CSP pregnancy and RCSP varies among 6 to 64 months,13 of which were shorter than 12 months. There were a variety of treatment options for RSCP,while most of them kept the same with the last time. 16 patients adopt the treatment exactly like the previous CSP. However,4 cases of 9,who took UAE both time,the repeated UAE group failed to accomplish the expected surgery because of the blocked uterine artery. 21 cases were able to keep their uterine after treatment. Conclusions： There is a higher risk for CSP patients to relapse in the subsequent pregnancy. The clinical manifestation and the ultrasound diagnosis criteria of RCSP are nearly the same with CSP. Gynecologist needs to consider the previous adopt treatment when comes to the option for the RCSP therapeutic management,especially for the repeated UAE cases. The resection of cesarean scar cannot prevent the recurrence of CSP.