剖宫产术后瘢痕处妊娠的临床分型、优化治疗及其意义

剖宫产术后瘢痕处妊娠(cesarean scar pregnancy,CSP)是一种非常特殊而危害性大的异位妊娠,目前世界范围内尚无统一的规范及处理方案。通过对CSP进行临床分型并根据其进行相应的临床决策及处理,能使CSP的治疗少消耗人力和物力。分型基本思路分为三个步骤:第一步分类,根据患者风险情况,决定处理时机;第二步分型,根据子宫切口肌壁最薄处厚度,确定处理方式;第三步分亚型,根据病灶位置高低,选择手术路径。相对于保守治疗、药物治疗等处理方案,手术治疗更加主动和迅速。各类型CSP可分别采用吸刮术、宫腔镜电切术、剖宫产切口部位病灶清除术(并切口部位修补)等手术方法予以治疗。

Clinical Classification and Meaning of Optimal Treatment of Cesarean Scar Pregnancy

Cesarean scar pregnancy (CSP) is a special form of ectopic pregnancy and there is no consensus or established guideline on the treatment of CSP. It can help us save resources if the treatments were preformed based on the clinical classification. There were three steps in the basic idea of the classification. Firstly, to categorize the patients into two different risk types which will determine the therapy time. Secondly, to distinguish surgical options after a confirmation of detailed CSP types. Last, the distinction of the subtypes can help us decide the approaching route. Surgical treatments are more initiative compared with conservative treatments. Different types of CSP can be treated by suction curettage, hysteroscopic excision and surgical resection.