剖宫产术后子宫瘢痕妊娠诊疗进展

目的：本文就近几年国内外剖宫产术后子宫瘢痕妊娠的临床表现与诊疗相关研究进行归纳总结，以期为妇产科医生在剖宫产术后子宫瘢痕妊娠诊疗工作提供参考。方法：检索CNKI、万方、Pubmed等数据库，利用文献追溯等途径收集国内外公开发表的关于剖宫产术后子宫瘢痕妊娠相关研究.结果：诊断方法主要有超声检查、MRI、宫腔镜、腹腔镜，组织病理学检查仍是诊断CSP的金标准.目前采用治疗方法有药物治疗、子宫动脉栓塞、手术治疗或多种方案联合治疗，临床中单一的治疗方式不理想，多倾向于联合治疗.目前Ⅰ级证据还没有提出，以至于目前还没有具体的基于证据的指南.临床上对待CSP患者应明确疾病的分型及各手术方式的优缺点，结合患者病情、生育要求、经济条件、医院设施等指标综合分析，选取合理的手术方式，方能最大限度减少患者治疗风险，获得良好预后并保存生育力.结论：对于CSP的早期诊断方法已明确，但最佳治疗方案和管理指南目前尚未达成共识，剖宫产术后子宫瘢痕妊娠诊治的治疗方法尚无统一标准，最理想的治疗方式需要大样本数据进行随机对照研究.

Advances in Diagnosis and Treatment of Uterine Scar Pregnancy After Cesarean Section

Study Objective:This article reviews the clinical manifestations and diagnosis and treatment of uterine scar pregnancy after cesarean section in recent years at home and abroad, with a view to providing a reference for gynecologists in the diagnosis and treatment of uterine scar pregnancy after cesarean section.Measurement: Search CNKI, Wanfang, Pubmed and other databases, and use literature tracing and other methods to collect publicly published relevant research on uterine scar pregnancy after cesarean section.Results: The main diagnostic methods are: ultrasound examination, MRI, hysteroscopy, laparoscopy, and histopathological examination are still the gold standard for the diagnosis of CSP. There are many ways to treat CSP. At present, level I evidence has not been proposed, so that there is no specific evidence-based guideline. The current treatment methods are: drug treatment, uterine artery embolization, surgical treatment or multiple treatments. Clinical treatment of CSP patients should clearly identify the type of disease and the advantages and disadvantages of various surgical procedures, combined with comprehensive analysis of the patient's condition, fertility requirements, economic conditions, hospital facilities and other indicators, and select a reasonable surgical method to minimize patient treatment. Risk, obtain a good prognosis and preserve fertility.Conclusion: For the early diagnosis of CSP method has been clear, but the best treatment plan and management guidelines at present has not yet reached a consensus that the uterus after cesarean section scar pregnancy diagnosis and treatment, there is no uniform standard, the most ideal treatment need large sample randomized controlled studies data.