剖宫产术后子宫瘢痕妊娠的诊治进展

Progress in the Diagnosis and Treatment of Caesarean Scar Pregnancy

剖宫产术后子宫瘢痕妊娠(caesarean scar pregnancy,CSP)是异位妊娠的一种类型,是一种危及生命的异常胚胎植入形式,是指在妊娠早期,受精卵着床于前次剖宫产子宫切口瘢痕处的异位妊娠。随着我国"全面两孩"政策的放开以及经阴道超声检查技术的发展,CSP的诊断率也随之增加,人们对CSP的认识也更加深入。CSP患者的临床表现差异较大,约1/3的患者在诊断时仍无症状,多达10%的CSP患者最初被误诊。虽然对于CSP的最佳治疗方案和管理指南目前尚未达成共识,但治疗的目标基本包含以下4点:终止妊娠、减少出血、预防子宫破裂并保留患者的生育能力。治疗方案包括期待治疗、药物治疗、子宫动脉栓塞术(UAE)、外科手术或联合治疗。本文综述了CSP的流行病学、临床表现、诊断标准和临床可实施的治疗方案。

Caesarean scar pregnancy(CSP)is a type of ectopic pregnancy,which is an abnormal and lifethreatening embryo implantation form.During early pregnancy,the fertilized egg is implanted in the scar of the previous uterine incision of cesarean section.With the opening universal two-child policy in our country,and with the development of transvaginal ultrasonography,the frequency of CSP diagnoses has increased as well.People′s understanding of CSP is also more profound.Clinical manifestations of CSP are various,even one third of CSP patients are asymptomatic at the time of diagnosis,as many as 10%of CSP cases could be initially misdiagnosed.Although there is no consensus on the best treatment plan and management guidelines for CSP,the treatment objectives basically include the following four points:to terminate pregnancy,to reduce bleeding,to prevent uterine rupture and to preserve fertility.Management options include expectant,medication,uterine artery embolization(UAE),surgery and a combination approach.In this review,we discuss the prevalence,diagnostic criteria,and clinically available treatment options of CSP.