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山东大学学报 (医学版) ›› 2023, Vol. 61 ›› Issue (11): 1-10.doi: 10.6040/j.issn.1671-7554.0.2023.0988

• 学术前沿 •    下一篇

剖宫产子宫瘢痕妊娠实用临床分型诊治专家共识

执笔专家: 班艳丽,赵颖,李桦,刘薇,荣风年,赵淑萍,崔保霞*()   

  1. 山东省医学会计划生育分会
  • 收稿日期:2023-11-06 出版日期:2023-11-10 发布日期:2023-12-12
  • 通讯作者: 崔保霞 E-mail:cuibaoxia@sdu.edu.cn
  • 基金资助:
    山东省自然科学基金面上项目(ZR2022MH192);山东大学科研项目(26010112002313)

Expert consensus of practical clinical classification system with optimal surgical strategy for cesarean scar pregnancy

Writing experts: Yanli BAN,Ying ZHAO,Hua LI,Wei LIU,Fengnian RONG,Shuping ZHAO,Baoxia CUI*()   

  1. Family Planning Branch of Shandong Provincial Medical Association
  • Received:2023-11-06 Online:2023-11-10 Published:2023-12-12
  • Contact: Baoxia CUI E-mail:cuibaoxia@sdu.edu.cn

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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

表1

瘢痕妊娠实用临床分型的分型标准及推荐的首选手术方式"

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*
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
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

图1

剖宫产术后子宫瘢痕妊娠临床分型的超声表现[6] A~C：显示Ⅰ型CSP，妊娠囊或包块位于瘢痕处，瘢痕处肌层厚度＞3 mm，无需考虑妊娠囊或包块大小；D~F：显示Ⅱa型CSP，妊娠囊或包块位于瘢痕处，瘢痕处肌层厚度介于1~3 mm之间，妊娠囊或包块平均直径≤30 mm；G~I：显示Ⅱb型CSP，妊娠囊或包块位于瘢痕处，前壁瘢痕处肌层厚度介于1~3 mm之间，妊娠囊或包块平均直径＞30 mm；J~L：显示Ⅲa型CSP，妊娠囊或包块位于瘢痕处，瘢痕处肌层厚度≤1 mm，妊娠囊或包块平均直径≤50 mm；M~O：显示Ⅲb型CSP，妊娠囊或包块位于瘢痕处为不均质包块，瘢痕处肌层厚度≤1 mm，妊娠囊或包块平均直径＞50 mm，周围有丰富血流信号。"

图2

剖宫产子宫瘢痕妊娠实用临床分型诊治策略"

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