复发性剖宫产瘢痕部位妊娠的临床分析

目的探讨复发性剖宫产瘢痕部位妊娠(RCSP)发生的相关因素及处理。方法选取2015年1月至2021年1月于川北医学院附属医院妇产科确诊的463例CSP并行聚焦超声消融(FUAS)或子宫动脉介入栓塞(UAE)联合宫腔镜手术治疗患者,随访其再妊娠情况,失访72例,成功随访391例,117例再次妊娠,24例为RCSP。回顾性分析RCSP患者的临床资料和处理方式。结果391例CSP患者,122例行FUAS联合宫腔镜手术,34例再次妊娠,5.9%(2/34)为RCSP;269例行UAE联合宫腔镜手术,83例再次妊娠,26.5%(22/83)为RCSP。UAE组RCSP发生率高于FUAS组,差异有统计学意义(P<0.05)。24例RCSP患者,22例行FUAS联合宫腔镜手术,2例行UAE联合宫腔镜手术,均一次性治疗成功。RCSP患者中,79.2%(19/24)剖宫产≥2次,87.5%(21/24)人工流产≥2次,70.8%(17/24)子宫下段瘢痕厚度≤3 mm。结论既往多次剖宫产史、多次人工流产史、子宫下段瘢痕厚度偏薄及CSP初次治疗方式可能与CSP复发相关。FUAS联合宫腔镜手术是CSP及RSCP的适宜治疗方式。

Clinical analysis for recurrent cesarean scar pregnancy

Objective To explore the related factors and treatment of recurrent cesarean section pregnancy(RCSP).Methods A total of 263 patients diagnosed as CSP and treated with focused ultrasound ablation(FUAS)or uterine artery embolization(UAE)combined with hysteroscopic surgery in Affiliated Hospital of North Sichuan Medical College from January 2015 to January 2021 were selected,and followed up for their re-pregnancy status.391 cases were successfully followed up and other 72 cases were lost.117 cases were re-pregnant,of whom 24 cases were RCSP.The clinical data and treatment methods of RCSP patients were analyzed retrospectively.Results Among the 391 CSP patients,122 cases underwent FUAS combined with hysteroscopic surgery,and 34 had re-pregnancy,5.9%(2/34)were RCSP.269 cases underwent UAE combined with hysteroscopy,and 83 had re-pregnancy,26.5%(22/83)were RCSP.The incidence of RCSP in UAE group was higher than that in FUAS group,and the difference was statistically significant(P<0.05).Among the 24 RCSP patients,91.7%(22/24)cases underwent FUAS combined with hysteroscopic surgery,8.3%(2/24)cases underwent UAE combined with hysteroscopic surgery,all of whom were successfully treated once.Among the RCSP patients,79.2%(19/24)cases had 2 or more times of cesarean sections,87.5%(21/24)cases had 2 or more times of artificial abortions,70.8%(17/24)cases of lower uterine scar thickness were less than or equal to 3 mm.Conclusion The history of multiple cesarean section,multiple artificial abortion,thin scar thickness in the lower segment of uterus and the first treatment of CSP may be related to the recurrence of CSP.FUAS surgery combined with hysteroscopy is an appropriate treatment for CSP and RCSP.