CAJ | 학술논문

随着剖宫产的增加，剖宫产术后子宫瘢痕妊娠（cesarean scar pregnancy，CSP）的发生率随着增加。其发生是因为剖宫产时子宫下段瘢痕愈合不良所致，随着经阴道超声诊断准确性的不断提高，目前CSP的诊断已不是临床难题。但在治疗方案选择上国际尚无统一标准，因为子宫CSP患者病情及就诊时情况面临的个体差异非常大，方案选择应当个体化，而个体化方案的选择缺乏规范化标准，是临床面临的主要难题。当前普遍认为，对于有手术指征者，尽早手术既可去除病灶，避免发生子宫破裂、大出血等危及生命的并发症甚至切除子宫而丧失生育能力，又可修复子宫瘢痕缺陷，降低再次妊娠的风险。腹腔镜在中国已经普及，许多医院都有腹腔镜手术的设备及技术，手术安全性及可行性无需置疑。综述近年腹腔镜在剖宫产术后子宫CSP中应用的相关报道，腹腔镜手术是手术患者的首选治疗措施，可将对患者生活质量的影响降至最低。但手术风险必须充分评估，由技术娴熟的医生主刀操作，术前必须准备好应对出血的措施，必要时转为子宫切除，术中要仔细检查有无膀胱损伤。
수착부궁산적증가，부궁산술후자궁반흔임신（cesarean scar pregnancy，CSP）적발생솔수착증가。기발생시인위부궁산시자궁하단반흔유합불량소치，수착경음도초성진단준학성적불단제고，목전CSP적진단이불시림상난제。단재치료방안선택상국제상무통일표준，인위자궁CSP환자병정급취진시정황면림적개체차이비상대，방안선택응당개체화，이개체화방안적선택결핍규범화표준，시림상면림적주요난제。당전보편인위，대우유수술지정자，진조수술기가거제병조，피면발생자궁파렬、대출혈등위급생명적병발증심지절제자궁이상실생육능력，우가수복자궁반흔결함，강저재차임신적풍험。복강경재중국이경보급，허다의원도유복강경수술적설비급기술，수술안전성급가행성무수치의。종술근년복강경재부궁산술후자궁CSP중응용적상관보도，복강경수술시수술환자적수선치료조시，가장대환자생활질량적영향강지최저。단수술풍험필수충분평고，유기술한숙적의생주도조작，술전필수준비호응대출혈적조시，필요시전위자궁절제，술중요자세검사유무방광손상。
The incidence rate of cesarean scar pregnancy (CSP) after cesarean section increases rapidly in recent years due to the increase of cesarean delivery. The CSP is caused by poor healing of lower uterine segment of cesarean section scar. Although with the progress in transvaginal ultrasonography, the diagnosis of these conditions is not the challenge for clinical doctor anymore, but the standardized management of CSP is not well established and the patient′s condition with CSP is various when visit the hospital, the treatment must be individualized as well. The main problem we face now is there has no standardized criteria for the selection of individualized treatment. The current opinion is that, for the patients with operation indications, operation can remove lesions as soon as possible could not only avoid life-threatening complications such as uterine rupture, hemorrhage, especially hysterectomy and loss of fertility, but also could repair the uterine scar defects and reduce the risk of CSP again. Laparoscopy had been widely used in China and many hospitals have the appropriate equipments and techniques, it is no doubt for operation safety and feasibility. In this review, we summarized the recent clinical researches about laparoscopic treatment cesarean scar pregnancy. The conclusion is that laparoscopic operation should be the first line treatment of CSP with operation indications, which had the lowest effect on the patient′s life quality after operation. However, there had several points needs to be fully evaluated, the operation should be done by skilled surgeon, always be ready for heavy hemorrhage in the operation and change to hysterectomy anytime necessary, injury of bladder should be carefully checked before the operation ends.