剖宫产瘢痕妊娠的病因及治疗进展

Etiology and treatment progress of cesarean scar pregnancy

剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)是一种特殊的异位妊娠,主要表现为妊娠囊和(或)胎盘着床于前次剖宫产瘢痕处(仅限于孕周≤12周)。随着医学影像学的进步,CSP越来越常见,发病率约为1∶1800[1]。过去几十年,伴随我国剖宫产数量的增加,CSP发生率也随之升高,尤其是在我国实施二孩政策后,CSP对女性的危害逐渐暴露出来。CSP是一种医源性疾病,可以造成术中及术后严重并发症,如难以控制的大出血、子宫破裂、周围脏器损伤甚至子宫切除等,严重威胁患者的生殖健康甚至生命。因此,早期诊断和治疗对妇女至关重要。目前对CSP的发病机制说法不一,对CSP治疗方案的选择国内外均没有规范化的标准和指南以及较好的循证医学证据,缺乏大样本量的随机对照研究。因此,本文将对CSP的病因及治疗进展进行综述,以期为CSP治疗方案的选择提供一定参考。

Cesarean scar pregnancy(CSP)is a special ectopic pregnancy,which mainly shows that the gestational sac and/or placenta are implanted in the scar of the previous cesarean section(limited to gestational weeks≤12 weeks).With the progress of medical imaging,CSP is becoming more and more common,with an incidence of about 1∶1800.In the past decades,with the increase of cesarean section in China,the incidence of CSP has also risen,and especially after the implementation of the two-child policy in China,the harm of CSP to women has been gradually exposed.CSP is a kind of iatrogenic disease,which may cause serious complications during and after the operation,such as uncontrollable massive bleeding,uterine rupture,peripheral organ damage and even hysterectomy,which seriously threaten the reproductive health and even life of patients.Therefore,early diagnosis and treatment are essential for women.At present,there are different opinions on the pathogenesis of CSP,there are no normalized standards and guidelines and good evidence-based medical evidence at home and abroad for the selection of CSP treatment schemes,and there is a lack of randomized controlled studies with large sample size.Therefore,this article will review the etiology and treatment progress of CSP,in order to provide some reference for the selection of CSP treatment.