复发性剖宫产瘢痕妊娠临床分析

目的 探讨复发性剖宫产瘢痕妊娠（recurrent cesarean scar pregnancy, RCSP）相关的高危因素，诊疗方法及预防措施。方法 回顾性分析2009年1月—2018年12月上海交通大学医学院附属国际和平妇幼保健院收治的26例RCSP患者的资料特点，比较剖宫产瘢痕妊娠（cesarean scar pregnancy, CSP）与RCSP临床表现、诊断情况、治疗方法并随访患者转归及再妊娠结局。结果 26例RCSP患者占同期收治的CSP的2.6%（26/1010），均为自然受孕。患者流产次数平均（2.73±0.73）次，2次及以上流产史者占92.3%（24/26）。1次剖宫产史者占69.2%（18/26），其中92.3%（24/26）的患者首次剖宫产手术时未进入临产产程；CSP与RCSP的孕周及临床表现无明显差异；RCSP较初次CSP的孕囊大小、血人绒毛膜促性腺激素（human chorionic gonadotropin, HCG）值均显著上升（P<0.05）；RCSP患者的子宫动脉栓塞联合化疗率（uterine artery embolization combined with methotrexate, UACE）及术中出血量均明显升高（P<0.05）；两者孕囊距浆膜面距离、胎心阳性率及宫内液性暗区例数之间均无明显差异（P>0.05）。结论 既往CSP史、临产前剖宫产史、多次流产史、胚胎活性高均是RCSP发生的高危因素。由于RCSP更易出现出血等手术并发症，应强调个体化治疗及预防RCSP发生。

Clinical analysis of recurrent cesarean scar pregnancy

Objective To investigate the risk factors, diagnosis, treatment and preventive measures of recurrent cesarean scar pregnancy (RCSP). Methods The clinical data of 26 RCSP patients admitted in our hospital from January 2009 to December 2018 were analyzed retrospectively. The clinical manifestations, diagnosis, treatment were compared between CSP and RCSP cases. The outcomes and repregnancy outcomes were followed up through telephone interview. Results Twenty-six patients with RCSP accounted for 2.6%(26/1010) of all CSP patients admitted at the same period and all of them got pregnant naturally. The average number of abortion was 2.73±0.73 and 92.3%(24/26) patients had two or more abortion. About 69.2%(18/26) patients had a history of single cesarean section, of which 92.3%(24/26) patients did not enter the labor process during the first cesarean section. There were no significant differences in gestational weeks and clinical manifestations between two groups. Compared with the first CSP, gestational sac size and serum human chorionic gonadotropin (HCG) level were significantly increased in RCSP. Uterine artery embolization combined with methotrexate (UACE) and blood lose were significantly increased in RCSP patients. There were no significant differences in distance from gestational sac to uterine serosal surface, positive rate of fetal heart rate and intrauterine fluid dark area between two groups. Conclusion The history of CSP, cesarean section before labor process, repeated abortion history and gestational sac activity are the risk factors for recurrent CSP. RCSP is more prone to complications such as bleeding, so individualized treatment and prevention of RCSP should be emphasized.