剖宫产瘢痕妊娠的治疗进展  

Progress in Treatment of Cesarean Scar Pregnancy

作　　者：阿斯燕.努斯拉提 林开清[1] 徐开红[1] 林俊[1] 

机构地区：[1]浙江大学医学院附属妇产科医院,杭州310006

出　　处：《国际妇产科学杂志》2015年第6期644-647,共4页Journal of International Obstetrics and Gynecology

摘　　要：剖宫产瘢痕妊娠是一种较罕见的异位妊娠,是剖宫产的远期并发症之一,可能引起患者严重出血甚至失血性休克,继续妊娠存在子宫破裂、危及患者生命可能。目前对该疾病的发病机制及治疗缺乏统一认识。甲氨蝶呤(MTX)等单纯药物治疗大出血风险高,可作为手术治疗的辅助治疗;清宫术创伤小但若适应证把握不明易导致大出血;术前行子宫动脉栓塞术可减少大出血,但费用贵且不良反应多;宫、腹腔镜作为新型微创手术其有效性需要更多的临床考证;经腹或经阴道局部病灶切除加修补术治疗的同时可修补瘢痕,但手术创伤大,应作为上述治疗失败的补充治疗。一线治疗方案仍需要大量的研究与探讨,因此临床上应根据患者综合情况选择合理的治疗方法。Cesarean scar pregnancy （CSP） is a very rare form of ectopic pregnancy and one of the long-term complications of cesarean section. A delay in diagnose or misdiagnose can lead to excessive hemorrhage, hemorrhagic shock , uterine rupture and may endanger the patient′s life. The pathogenesis of CSP is unknown and there is currently no consensus on the treatment. Simple methotrexate treatment has a high risk of hemorrhage, but it can be an adjuvant therapy for surgical treatment. Uterine curettage is a less invasive treatment, but it can also lead to a massive bleeding if you don′t know the indications well. Preoperative uterine artery embolization can reduce the bleeding, but it has many adverse reactions and it′s high priced. Given the lack of the sufficient evidence on the outcome of hysteroscopic, laparoscopic, these interventions should be applied in a research setting with long-term follow-up. Although transabdominal or tansvaginal local lesion resection with repair can treat the disease and remove the old scar, it is more invasive and should be the supplementary treatment of the precious treatments only. The first line treatment still needs a large number of study and research, therefore, the management plan should be individually tailored.

关 键 词：瘢痕 剖宫产术 妊娠 异位 治疗 

分 类 号：R713.8[医药卫生—妇产科学]