剖宫产子宫瘢痕妊娠实用临床分型诊治专家共识

doi:10.6040/j.issn.1671-7554.0.2023.0988

摘要/Abstract

摘要：

剖宫产子宫瘢痕妊娠(CSP)是妊娠囊着床于剖宫产子宫切口瘢痕处的一种特殊部位的异位妊娠。若CSP未经恰当的诊疗，可导致大出血、子宫破裂等危及生命的并发症，严重影响患者的生育力及身心健康。虽然CSP的治疗方式多样，但临床实践中仍缺乏被临床广泛应用的共识或指南来指导最佳治疗方案的选择。近年来瘢痕妊娠的分型诊治越来越受重视。瘢痕妊娠实用临床分型在山东省已得到较广泛的验证，针对每种类型推荐最佳治疗方案，治疗效果可靠, 具有较高的临床应用价值。因此，本专家组结合近年积累的临床经验及最新的临床研究结果，在实用临床分型诊治策略基础上，制定关于CSP分型诊治的专家共识，以期规范临床诊疗行为，指导临床工作。

关键词: 剖宫产子宫瘢痕妊娠, 异位妊娠, 临床分型, 治疗, 专家共识

Abstract:

Cesarean scar pregnancy (CSP) is a special type of ectopic pregnancy in which a pregnancy sac is implanted at the scar of a previous caesarean section. Without appropriate diagnosis or treatment, it can lead to severe morbidity such as life-threatening massive hemorrhage, and uterine rupture, with subsequent effect of fertility, physical and mental health of patients. Although many different treatment options have been described, there is still no consensus on the optimal surgical treatment strategy. In recent years, treatment of CSP based on classification has drawn more and more attention. The practical clinical classification system with optimal surgical strategy for CSP has been widely validated in Shandong Province, which shows good application value and reliable therapeutic effects. Based on this classification system, and combined with clinical experience and the latest clinical research results, the expert consensus of clinical classification system and surgical strategy for CSP is formulated, aiming to standardize the clinical diagnosis and treatment, and to guide clinical work.

Key words: Cesarean scar pregnancy, Ectopic pregnancy, Clinical classification, Treatment, Expert consensus

中图分类号:

R713.8

执笔专家: 班艳丽, 赵颖, 李桦, 刘薇, 荣风年, 赵淑萍, 崔保霞. 剖宫产子宫瘢痕妊娠实用临床分型诊治专家共识[J]. 山东大学学报 (医学版), 2023, 61(11): 1-10.

Writing experts: BAN Yanli, ZHAO Ying, LI Hua, LIU Wei, RONG Fengnian, ZHAO Shuping, CUI Baoxia. Expert consensus of practical clinical classification system with optimal surgical strategy for cesarean scar pregnancy[J]. Journal of Shandong University (Health Sciences), 2023, 61(11): 1-10.

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实用临床分型	前壁肌层厚度	妊娠囊或包块平均直径	推荐的首选手术方式
Ⅰ型	＞3 mm	无论大小	超声监视下负压吸宫术±宫腔镜手术^*
Ⅱ型	≤3 mm且＞1 mm	Ⅱa≤30 mm	超声监视下负压吸宫术+宫腔镜手术^*
Ⅱ型	≤3 mm且＞1 mm	Ⅱb＞30 mm	腹腔镜监视下负压吸宫术+宫腔镜手术^* 必要时腹腔镜下瘢痕缺陷修补术或经阴道前穹隆切开病灶切除术
Ⅲ型	≤1 mm	Ⅲa≤50 mm	腹腔镜下瘢痕妊娠病灶切除+缺陷修补术+负压吸宫术或经阴道前穹隆切开病灶切除术
Ⅲ型	≤1 mm	Ⅲb＞50 mm, 或伴有动静脉畸形	子宫动脉栓塞/子宫动脉暂时性阻断后腹腔镜下瘢痕妊娠病灶切除+缺陷修补+负压吸宫术或开腹瘢痕妊娠病灶切除术+缺陷修补术

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