中国剖宫产瘢痕部位妊娠文献调查与思考

Chinese literature analysis and consideration of cesarean scar pregnancy

目的了解剖宫产瘢痕部位妊娠(cesarean scar pregnancy,CSP)现状。方法在"万方数据"中,逐条下载、学习关于CSP所有中文文章,按"发表时间"所在年度、"作者单位"所在省/直辖市和所在医院等级、相关合并症等进行统计分析。结果 (1)万方数据中关于CSP的文献共4 784篇,共计138 188病例,最早发表于1999年,按"发表时间"所在年度进行统计,随着年度增长,无论是文献数还是病例数,其构成比均呈逐年迅速增加趋势。(2)"作者单位"所涉及的省/直辖市共有30个,占88.24%。"作者单位"前5位省份是河南、广东、江苏、浙江和湖北省,最后5位是黑龙江、海南、宁夏、甘肃和青海省。(3)按"作者单位"所在医院级别进行统计,三级医院、二级医院、一级医院、计划生育指导服务站等其他医疗单位及无法考查"作者单位"所在医院级别或未记录"作者单位"的文献数分别占59.39%、31.00%、2.72%、1.44%及5.45%,病例数分别占59.68%、31.35%、2.74%、1.22%及5.01%。结论提高CSP认识,控制剖宫产率,特别是减少社会因素剖宫产,提高产科质量与手术质量,注重剖宫产术中"子宫切口处理模式",进行前瞻性、大样本、多角度、多中心的临床观察和研究,以期找到CSP病因或危险因素,避免或减少CSP的发生,避免发生医源性并发症与医疗纠纷,提高广大育龄妇女的身体、心理健康与生活质量,是产科医师当前面临的重要课题。

Objective To investigate the present situation of Chinese literature on cesarean scar pregnancy. Methods We conducted an electronic based search on Wanfang Data to learn all the articles on CSP. Statistical analysis was conducted according to the province or municipality of the author＇s institution,the year of publication time,the rank of hospital of the author＇s institution and related complications. Results（1） There were 4 784 CSP literatures in the Wanfang data,enrolling 138 188 cases,originally published in 1999,the number of literatures and cases increased rapidly year by year according to the year of the publication time.（2） The author＇s unit covered 30 provinces or municipalities,accounting for 88. 24%（ 30/34）. The top five provinces are Henan,Guangdong,Jiangsu,Zhejiang and Hubei,and the last five are Heilongjiang,Hainan,Ningxia,Gansu and Qinghai.（3） Statistics analysis was conducted according to the rank of hospital of the author＇s institution,including tertiary hospitals,secondary hospitals,primary hospitals,other medical institutions like family planning guidance service station and unclear rank of author＇s institution. The number of literatures were 59. 39%,31. 00%,2. 72%,1. 44% and 5. 45%,respectively. Meanwhile,the number of cases were 59. 68%,31. 35%,2. 74%,1. 22% and 5. 01%,respectively. Conclusion Improving the understanding of CSP,controlling the rate of cesarean section（ CSR）,especially CSR due to social factors,enhancing the quality of operation,finding the etiology and risk factors of CSP to reduce the occurrence,avoiding iatrogenic complications,and improving the physical and psychological health of women are all important issues obstetrician are facing.