{"id":45043,"date":"2024-12-16T05:10:28","date_gmt":"2024-12-16T05:10:28","guid":{"rendered":"https:\/\/zydq.1006ss.com\/?p=45043"},"modified":"2024-12-16T05:10:28","modified_gmt":"2024-12-16T05:10:28","slug":"%e3%80%90%e4%b8%93%e5%ae%b6%e5%85%b1%e8%af%86%e3%80%91%e5%89%96%e5%ae%ab%e4%ba%a7%e5%ad%90%e5%ae%ab%e7%98%a2%e7%97%95%e5%a6%8a%e5%a8%a0%e5%ae%9e%e7%94%a8%e4%b8%b4%e5%ba%8a%e5%88%86%e5%9e%8b%e8%af%8a","status":"publish","type":"post","link":"http:\/\/zydq.1006ss.com\/?p=45043","title":{"rendered":"\u3010\u4e13\u5bb6\u5171\u8bc6\u3011\u5256\u5bab\u4ea7\u5b50\u5bab\u7622\u75d5\u598a\u5a20\u5b9e\u7528\u4e34\u5e8a\u5206\u578b\u8bca\u6cbb\u4e13\u5bb6\u5171\u8bc6"},"content":{"rendered":"

\u672c\u6587\u520a\u767b\u4e8e\u300a\u5c71\u4e1c\u5927\u5b66\u5b66\u62a5\uff08\u533b\u5b66\u7248\uff09\u300b2023,61(11)\uff1a1-10<\/p>\n

doi:10.6040\/j.issn.1671-7554.0.2023.0988<\/p>\n<\/p>\n

<\/h2>\n

\u5256\u5bab\u4ea7\u5b50\u5bab\u7622\u75d5\u598a\u5a20\u5b9e\u7528\u4e34\u5e8a\u5206\u578b\u8bca\u6cbb\u4e13\u5bb6\u5171\u8bc6<\/h2>\n

\u6267\u7b14\u4e13\u5bb6:\u73ed\u8273\u4e3d, \u8d75\u9896, \u674e\u6866, \u5218\u8587, \u8363\u98ce\u5e74, \u8d75\u6dd1\u840d, \u5d14\u4fdd\u971e<\/p>\n

\u5c71\u4e1c\u7701\u533b\u5b66\u4f1a\u8ba1\u5212\u751f\u80b2\u5206\u4f1a<\/p>\n

Expert consensus of practical clinical classification system with optimal surgical strategy for cesarean scar pregnancy<\/h2>\n

BAN Yanli,  Writing experts: ZHAO Ying, LI Hua, LIU Wei, RONG Fengnian, ZHAO Shuping, CUI Baoxia<\/p>\n

Family Planning Branch of Shandong Provincial Medical Association<\/p>\n<\/p>\n

Abstract<\/p>\n

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.<\/p>\n

Keywords\uff1a Cesarean scar pregnancy ; Ectopic pregnancy ; Clinical classification ; Treatment ; Expert consensus<\/p>\n

PDF (6842KB) <\/p>\n

\u672c\u6587\u5f15\u7528\u683c\u5f0f<\/p>\n

\u6267\u7b14\u4e13\u5bb6:\u73ed\u8273\u4e3d, \u8d75\u9896, \u674e\u6866, \u5218\u8587, \u8363\u98ce\u5e74, \u8d75\u6dd1\u840d, \u5d14\u4fdd\u971e. \u5256\u5bab\u4ea7\u5b50\u5bab\u7622\u75d5\u598a\u5a20\u5b9e\u7528\u4e34\u5e8a\u5206\u578b\u8bca\u6cbb\u4e13\u5bb6\u5171\u8bc6. \u5c71\u4e1c\u5927\u5b66\u5b66\u62a5(\u533b\u5b66\u7248)[J], 2023, 61(11): 1-10 doi:10.6040\/j.issn.1671-7554.0.2023.0988<\/p>\n

BAN Yanli, Writing experts: ZHAO Ying, LI Hua, LIU Wei, RONG Fengnian, ZHAO Shuping, CUI Baoxia. Expert consensus of practical clinical classification system with optimal surgical strategy for cesarean scar pregnancy. Journal of Shandong University(Health Sciences)[J], 2023, 61(11): 1-10 doi:10.6040\/j.issn.1671-7554.0.2023.0988<\/p>\n

<\/h2>\n

\u5256\u5bab\u4ea7\u5b50\u5bab\u7622\u75d5\u598a\u5a20(cesarean scar pregnancy, CSP)\uff0c\u53c8\u79f0\u4e3a\u5256\u5bab\u4ea7\u5b50\u5bab\u7622\u75d5\u5f02\u4f4d\u598a\u5a20(cesarean scar ectopic pregnancy, CSEP)\uff0c\u7b80\u79f0\u7622\u75d5\u598a\u5a20\uff0c\u662f\u6307\u53d7\u7cbe\u5375\u7740\u5e8a\u4e8e\u5256\u5bab\u4ea7\u5b50\u5bab\u5207\u53e3\u7622\u75d5\u5904\u7684\u4e00\u79cd\u7279\u6b8a\u7c7b\u578b\u7684\u5f02\u4f4d\u598a\u5a20\uff0c\u5c5e\u4e8e\u5256\u5bab\u4ea7\u672f\u7684\u4e00\u79cd\u8fdc\u671f\u5e76\u53d1\u75c7\u3002\u672c\u6587\u4ec5\u5305\u62ec\u598a\u5a20\u226412\u5468\u7684CSP\u3002\u8fd1\u5e74\u6765\uff0c\u4e16\u754c\u8303\u56f4\u5185CSP\u7684\u53d1\u75c5\u7387\u5448\u4e0a\u5347\u8d8b\u52bf[1]\uff0c\u7531\u4e8e\u6211\u56fd\u8f83\u9ad8\u7684\u5256\u5bab\u4ea7\u7387\uff0cCSP\u53d1\u75c5\u7387\u8f83\u9ad8[2-3]\u3002<\/p>\n

\u82e5CSP\u6ca1\u6709\u5f97\u5230\u6070\u5f53\u7684\u8bca\u6cbb\uff0c\u53ef\u5bfc\u81f4\u5371\u53ca\u751f\u547d\u7684\u5927\u91cf\u5b50\u5bab\u51fa\u8840\u3001\u5b50\u5bab\u7834\u88c2\uff0c\u751a\u81f3\u5b50\u5bab\u5207\u9664\u672f\u7b49\u4e25\u91cd\u5e76\u53d1\u75c7\u7684\u53d1\u751f\uff0c\u4e25\u91cd\u5f71\u54cd\u60a3\u8005\u7684\u751f\u80b2\u529b\u53ca\u8eab\u5fc3\u5065\u5eb7\u3002\u4e3a\u4e86\u6307\u5bfcCSP\u7684\u89c4\u8303\u8bca\u6cbb\uff0c\u4e2d\u534e\u533b\u5b66\u4f1a\u4e8e2016\u5e74\u66f4\u65b0\u5e76\u53d1\u5e03\u4e86\u300a\u5256\u5bab\u4ea7\u672f\u540e\u5b50\u5bab\u7622\u75d5\u598a\u5a20\u8bca\u6cbb\u4e13\u5bb6\u5171\u8bc6\u300b[4]\u30022020\u5e74\u7f8e\u56fd\u6bcd\u80ce\u533b\u5b66\u4f1a(Society for Maternal-Fetal Medicine, SMFM) \u7efc\u5408\u6587\u732e\uff0c\u5236\u5b9a\u4e86\u300a#49\uff1a\u5256\u5bab\u4ea7\u7622\u75d5\u598a\u5a20\u6307\u5357\u300b[5]\uff0c\u5e76\u4e8e2022\u5e74\u66f4\u65b0\u53d1\u5e03\u4e86\u300a#63\uff1a\u5256\u5bab\u4ea7\u7622\u75d5\u598a\u5a20\u6307\u5357\u300b[1]\u3002\u8fd9\u4e9b\u56fd\u5185\u5916\u5171\u8bc6\u53ca\u6307\u5357\u5bf9CSP\u7684\u8bca\u6cbb\u5177\u6709\u91cd\u8981\u7684\u4e34\u5e8a\u6307\u5bfc\u610f\u4e49\uff0c\u4f46\u4ecd\u4e0d\u80fd\u6ee1\u8db3\u5b9e\u9645\u4e34\u5e8a\u5e94\u7528\uff0c\u8feb\u5207\u9700\u8981\u80fd\u591f\u88ab\u4e34\u5e8a\u5e7f\u6cdb\u5e94\u7528\u7684\u5171\u8bc6\u6216\u6307\u5357\u6765\u6307\u5bfc\u4e2a\u4f53\u5316\u3001\u6700\u4f73\u6cbb\u7597\u65b9\u6848\u7684\u9009\u62e9\u3002<\/p>\n

\u7814\u7a76\u8868\u660e\uff0cCSP\u7684\u4e34\u5e8a\u7c7b\u578b\u4e0d\u540c\uff0c\u5927\u51fa\u8840\u98ce\u9669\u53ca\u9884\u540e\u5b58\u5728\u5dee\u5f02\uff0c\u51c6\u786e\u7684\u4e34\u5e8a\u5206\u578b\u7cfb\u7edf\u6709\u52a9\u4e8e\u6307\u5bfc\u9009\u62e9\u6700\u4f73\u7684\u6cbb\u7597\u65b9\u6848\u3002\u7136\u800c\uff0c\u4ee5\u5f80\u7684\u5206\u578b\u7cfb\u7edf\u6240\u91c7\u7528\u7684\u8d85\u58f0\u6307\u6807\u6bd4\u8f83\u5bbd\u6cdb\uff0c\u5e76\u6ca1\u6709\u9488\u5bf9\u6bcf\u4e00\u7c7b\u578b\u63d0\u51fa\u5177\u4f53\u7684\u4e34\u5e8a\u6cbb\u7597\u65b9\u6848\u3002\u8fd1\u5e74\u6765\uff0c\u6211\u7701\u6240\u63a8\u884c\u7684\u57fa\u4e8e\u7622\u75d5\u598a\u5a20\u5b9e\u7528\u4e34\u5e8a\u5206\u578b\u5bf9CSP\u8fdb\u884c\u8be6\u7ec6\u5206\u578b\uff0c\u5e76\u9488\u5bf9\u6bcf\u79cd\u7c7b\u578b\u63a8\u8350\u4e86\u6700\u4f18\u624b\u672f\u6cbb\u7597\u65b9\u6848\uff0c\u4e34\u5e8a\u6cbb\u7597\u6548\u679c\u53ef\u9760\uff0c\u5177\u6709\u8f83\u9ad8\u7684\u4e34\u5e8a\u5e94\u7528\u4ef7\u503c[6-7]\u3002\u56e0\u6b64\uff0c\u672c\u4e13\u5bb6\u7ec4\u7ed3\u5408\u8fd1\u5e74\u79ef\u7d2f\u7684\u4e34\u5e8a\u7ecf\u9a8c\u53ca\u6700\u65b0\u7684\u4e34\u5e8a\u7814\u7a76\u7ed3\u679c\uff0c\u5728\u5b9e\u7528\u4e34\u5e8a\u5206\u578b\u8bca\u6cbb\u7b56\u7565\u4ee5\u53ca\u4e0a\u8ff0\u5171\u8bc6\u548c\u6307\u5357\u7684\u57fa\u7840\u4e0a\uff0c\u5236\u5b9a\u6b64\u5173\u4e8eCSP\u5206\u578b\u8bca\u6cbb\u7684\u4e13\u5bb6\u5171\u8bc6\uff0c\u4ee5\u671f\u89c4\u8303\u4e34\u5e8a\u8bca\u7597\u884c\u4e3a\uff0c\u6307\u5bfc\u4e34\u5e8a\u5de5\u4f5c\u3002<\/p>\n

1 CSP\u7684\u53d1\u75c5\u673a\u5236<\/h2>\n

CSP\u7684\u75c5\u56e0\u5c1a\u4e0d\u6e05\u695a\uff0c\u63a8\u6d4b\u53ef\u80fd\u7531\u4e8e\u5256\u5bab\u4ea7\u672f\u540e\u5b50\u5bab\u5207\u53e3\u6108\u5408\u4e0d\u826f\uff0c\u7622\u75d5\u90e8\u4f4d\u5f62\u6210\u5fae\u5c0f\u88c2\u9699\uff0c\u5bab\u8154\u5fae\u73af\u5883\u53d7\u5bab\u8154\u64cd\u4f5c\u3001\u5bab\u8154\u7c98\u8fde\u7b49\u56e0\u7d20\u5f71\u54cd\u4e0d\u5229\u4e8e\u53d7\u7cbe\u5375\u79cd\u690d\uff0c\u6216\u53d7\u7cbe\u5375\u53d1\u80b2\u8fdf\u7f13\u6216\u8fd0\u884c\u8fc7\u5feb\uff0c\u901a\u8fc7\u5fae\u5c0f\u88c2\u9699\u8fdb\u5165\u5b50\u5bab\u808c\u5c42\u800c\u7740\u5e8a[8-10]\u3002\u7531\u4e8e\u7622\u75d5\u5904\u808c\u5c42\u8584\u5f31\u5e76\u7ea4\u7ef4\u5316\uff0c\u968f\u7740\u598a\u5a20\u7ee7\u7eed\u5b55\u56ca\u589e\u5927\uff0c\u6709\u53ef\u80fd\u53d1\u751f\u7622\u75d5\u5904\u7834\u88c2\u3001\u5927\u51fa\u8840\u3001\u80ce\u76d8\u690d\u5165\u6027\u75be\u75c5(placenta accreta spectrum, PAS)\u751a\u81f3\u5371\u53ca\u6bcd\u80ce\u751f\u547d\u7b49\u98ce\u9669\u3002\u7814\u7a76\u663e\u793a\uff0cCSP\u4e0ePAS\u5177\u6709\u76f8\u4f3c\u7684\u53d1\u75c5\u8fc7\u7a0b\uff0cCSP\u7ee7\u7eed\u598a\u5a20\u5c06\u53d1\u5c55\u4e3aPAS\uff0c\u63d0\u793aCSP\u662fPAS\u7684\u5148\u671f\u75c5\u53d8\uff0c\u4e8c\u8005\u5c5e\u4e8e\u540c\u4e00\u75be\u75c5\u7684\u4e0d\u540c\u53d1\u5c55\u9636\u6bb5[11]\u3002\u75c5\u7406\u5b66\u53d1\u73b0\u4e24\u8005\u5747\u6709\u7ed2\u6bdb\u6d78\u6da6\u81f3\u7622\u75d5\u808c\u5c42\u7ec4\u7ec7\u5185\u3001\u8715\u819c\u53d8\u8584\u6216\u7f3a\u5931[12]\u3002<\/p>\n

\u7814\u7a76\u8868\u660e\uff0cCSP\u53d1\u751f\u7684\u9ad8\u5371\u56e0\u7d20\u5305\u62ec\u81c0\u4f4d\u5256\u5bab\u4ea7[13]\u3001\u8ddd\u524d\u6b21\u5256\u5bab\u4ea7\u5c0f\u4e8e2\u5e74[14]\u3002\u5256\u5bab\u4ea7\u53f2\u867d\u7136\u662fCSP\u53d1\u751f\u7684\u524d\u63d0\u6761\u4ef6\uff0c\u4f46\u5256\u5bab\u4ea7\u6b21\u6570\u589e\u591a\u5e76\u4e0d\u589e\u52a0CSP\u7684\u98ce\u9669[15]\u3002\u867d\u7136\u7814\u7a76\u8ba4\u4e3a\u5b50\u5bab\u5207\u53e3\u53cc\u5c42\u7f1d\u5408\u4e0e\u5355\u5c42\u7f1d\u5408\u76f8\u6bd4\uff0c\u6709\u5229\u4e8e\u589e\u52a0\u7622\u75d5\u5904\u6b8b\u4f59\u808c\u5c42\u7684\u539a\u5ea6[16]\uff0c\u53ef\u80fd\u4f1a\u51cf\u5c11CSP\u7684\u53d1\u751f\u7387\uff0c\u4f46\u662f\u5b50\u5bab\u7f1d\u5408\u6280\u672f\u4e0eCSP\u53d1\u751f\u7684\u5173\u7cfb\u6709\u5f85\u8fdb\u4e00\u6b65\u63a2\u8ba8\u3002<\/p>\n

2 CSP\u7684\u4e34\u5e8a\u8868\u73b0<\/h2>\n

CSP\u7684\u4e34\u5e8a\u8868\u73b0\u7f3a\u4e4f\u7279\u5f02\u6027\uff0c\u4e3b\u8981\u4e3a\u505c\u7ecf\u540e\u9634\u9053\u6d41\u8840\uff0c\u6709\u65f6\u4f34\u6709\u4e0b\u8179\u75db\uff0c\u6709\u5927\u7ea630%\u7684\u60a3\u8005\u6ca1\u6709\u4e34\u5e8a\u75c7\u72b6\u4ec5\u5728\u8d85\u58f0\u68c0\u67e5\u65f6\u88ab\u53d1\u73b0[13, 17]\u3002\u4e5f\u6709\u90e8\u5206\u60a3\u8005\u521d\u8bca\u4e3a\u5bab\u5185\u65e9\u5b55\u3001\u96be\u514d\u6d41\u4ea7\u6216\u4e0d\u5168\u6d41\u4ea7\uff0c\u5728\u884c\u4eba\u5de5\u6d41\u4ea7\u672f\u3001\u836f\u7269\u6d41\u4ea7\u6216\u6e05\u5bab\u672f\u8fc7\u7a0b\u4e2d\u51fa\u73b0\u5927\u91cf\u9634\u9053\u6d41\u8840\u65f6\u624d\u88ab\u8bca\u65ad\u3002\u4ecd\u6709\u5927\u7ea625%\u7684\u60a3\u8005\u56e0\u6ca1\u6709\u4e34\u5e8a\u75c7\u72b6\u800c\u672a\u5728\u65e9\u5b55\u671f\u88ab\u786e\u8bca[18]\u3002\u5f53CSP\u672a\u88ab\u53ca\u65f6\u8bca\u65ad\u3001\u4e25\u5bc6\u76d1\u6d4b\u6216\u6070\u5f53\u5904\u7406\u65f6\uff0c\u53ef\u53d1\u751f\u5927\u51fa\u8840\u3001\u5b50\u5bab\u7834\u88c2\u7b49\u4e25\u91cd\u5e76\u53d1\u75c7\uff0c\u5bfc\u81f4\u5931\u8840\u6027\u4f11\u514b\uff0c\u751a\u81f3\u5371\u53ca\u60a3\u8005\u751f\u547d\u3002<\/p>\n

3 CSP\u672f\u4e2d\u5927\u51fa\u8840\u7684\u9ad8\u5371\u56e0\u7d20<\/h2>\n

\u63a2\u8ba8CSP\u672f\u4e2d\u5927\u51fa\u8840\u76f8\u5173\u7684\u9ad8\u5371\u56e0\u7d20\u6709\u52a9\u4e8e\u9884\u6d4b\u672f\u4e2d\u5927\u51fa\u8840\u7684\u98ce\u9669\uff0c\u5e76\u80fd\u6307\u5bfc\u4e34\u5e8a\u5206\u578b\u8bca\u65ad\u4e0e\u6cbb\u7597\u9009\u62e9\u3002\u56de\u987e\u6027\u7814\u7a76\u53d1\u73b0CSP\u672f\u4e2d\u5927\u51fa\u8840\u7684\u5371\u9669\u56e0\u7d20\u5305\u62ec\u598a\u5a20\u6b21\u6570\u591a\u3001\u5b55\u5468\u5927\u3001\u5b55\u56ca\u6216\u5305\u5757\u8f83\u5927\u3001\u524d\u58c1\u808c\u5c42\u8584\u5f31\u3001\u8840\u4eba\u7ed2\u6bdb\u819c\u4fc3\u6027\u817a\u6fc0\u7d20(human chorionic gonadotropin, \u03b2-HCG)\u6c34\u5e73\u9ad8\u3001\u5b55\u56ca\u5468\u56f4\u8840\u6d41\u4e30\u5bcc\u7b49[19-21]\u3002\u4e0d\u540c\u7814\u7a76\u5206\u6790\u5f97\u51fa\u7684\u9ad8\u5371\u56e0\u7d20\u4e0d\u5c3d\u76f8\u540c\uff0c\u8fd9\u53ef\u80fd\u4e0e\u91c7\u7528\u7684\u6cbb\u7597\u65b9\u5f0f\u6709\u5173\uff0c\u4f46\u662f\u591a\u6570\u7814\u7a76\u5747\u652f\u6301\u524d\u58c1\u808c\u5c42\u539a\u5ea6\u53ca\u5b55\u56ca\u5927\u5c0f\u662f\u9884\u6d4b\u672f\u4e2d\u5927\u51fa\u8840\u7684\u91cd\u8981\u63d0\u6807\u3002Ban\u7b49[6]\u901a\u8fc7\u591a\u56e0\u7d20Logistic\u56de\u5f52\u5206\u6790\u53d1\u73b0\uff0c\u7622\u75d5\u5904\u808c\u5c42\u539a\u5ea6(OR\uff1a0.51\uff0c95%CI\uff1a0.36~0.73)\u4e0e\u5b55\u56ca\u6216\u5305\u5757\u5e73\u5747\u76f4\u5f84(OR\uff1a1.10\uff0c95%CI\uff1a1.07~1.14) \u662fCSP\u672f\u4e2d\u5927\u51fa\u8840\u7684\u72ec\u7acb\u5371\u9669\u56e0\u7d20\uff0c\u63d0\u793a\u5176\u53ef\u4f5c\u4e3a\u6cbb\u7597\u65b9\u5f0f\u9009\u62e9\u7684\u91cd\u8981\u4f9d\u636e\u3002<\/p>\n

4 CSP\u7684\u8bca\u65ad<\/h2>\n

\u8d85\u58f0\u68c0\u67e5\uff0c\u5c24\u5176\u7ecf\u9634\u9053\u8d85\u58f0\uff0c\u88ab\u8ba4\u4e3a\u662f\u8bca\u65adCSP\u7684\u9996\u9009\u65b9\u6cd5[22]\u3002\u7ecf\u9634\u8d85\u58f0\u4e0d\u4ec5\u53ef\u4ee5\u660e\u786e\u598a\u5a20\u56ca\u7684\u4f4d\u7f6e\u3001\u5927\u5c0f\u3001\u7622\u75d5\u5904\u808c\u5c42\u539a\u5ea6\u3001\u5468\u56f4\u8840\u6d41\u60c5\u51b5\uff0c\u8fd8\u53ef\u4ee5\u5224\u65ad\u5b50\u5bab\u7622\u75d5\u5904\u662f\u5426\u5916\u51f8\u53ca\u4e0e\u8180\u80f1\u7684\u5173\u7cfb\u3002\u7ecf\u9634\u8054\u5408\u7ecf\u8179\u8d85\u58f0\u53ef\u5168\u9762\u8bc4\u4f30\u5b50\u5bab\u7684\u8f6e\u5ed3\u3001\u662f\u5426\u5916\u51f8\u4ee5\u53ca\u4e0e\u8180\u80f1\u7684\u5173\u7cfb\uff0c\u6709\u52a9\u4e8e\u63d0\u9ad8\u8bca\u65ad\u7387\u53ca\u8fdb\u884c\u4e34\u5e8a\u5206\u578b\u3002\u5178\u578b\u7684\u7ecf\u9634\u9053\u8d85\u58f0\u8868\u73b0\u4e3a\uff1a\u2460\u5bab\u8154\u53ca\u5bab\u9888\u7ba1\u5185\u672a\u89c1\u598a\u5a20\u56ca; \u2461\u598a\u5a20\u56ca\u7740\u5e8a\u4e8e\u5b50\u5bab\u7622\u75d5\u5904\u808c\u5c42\uff0c\u90e8\u5206\u53ef\u89c1\u80da\u82bd\u6216\u80ce\u5fc3\u640f\u52a8; \u2462\u598a\u5a20\u56ca\u4e0e\u8180\u80f1\u4e4b\u95f4\u7684\u5b50\u5bab\u524d\u58c1\u808c\u5c42\u660e\u663e\u53d8\u8584\u751a\u81f3\u8fde\u7eed\u6027\u4e2d\u65ad; \u2463\u5f69\u8272\u591a\u666e\u52d2\u8840\u6d41\u663e\u50cf(color doppler flow imaging, CDFI)\u663e\u793a\u598a\u5a20\u56ca\u5468\u8fb9\u6709\u4e30\u5bcc\u8840\u6d41\u4fe1\u53f7\uff0c\u751a\u81f3\u5448\u73b0\u9ad8\u901f\u4f4e\u963b\u7684\u8840\u6d41\u4fe1\u53f7[22-24]\u3002\u7ecf\u8179\u8d85\u58f0\u77e2\u72b6\u4f4d\u56fe\u50cf\u53d1\u73b0\u5b50\u5bab\u4e0b\u6bb5\u81a8\u9686\u5916\u51f8\uff0c\u5219\u6709\u52a9\u4e8eCSP\u7684\u8bca\u65ad[25]\u3002\u5f53\u7136\uff0c\u5e76\u975e\u6240\u6709CSP\u7684\u8d85\u58f0\u8868\u73b0\u5747\u7b26\u5408\u4e0a\u8ff0\u6240\u6709\u7684\u5178\u578b\u7279\u5f81\uff0c\u90e8\u5206\u60a3\u8005\u7684\u5b55\u56ca\u53ef\u80fd\u7d27\u90bb\u7622\u75d5\u5904\u6216\u8840\u6d41\u7a00\u758f\u3002\u7ecf\u9634\u9053\u8d85\u58f0\u8bca\u65adCSP\u7684\u6700\u4f73\u5b55\u5468\u662f6~7\u5468\uff0c\u968f\u7740\u5b55\u5468\u7684\u589e\u52a0\uff0c\u8bca\u65ad\u96be\u5ea6\u589e\u52a0\uff0c\u4e34\u5e8a\u5206\u578b\u4e5f\u53ef\u80fd\u968f\u4e4b\u6539\u53d8\uff0c\u56e0\u6b64\u5fc5\u8981\u65f6\u9700\u8981\u52a8\u6001\u76d1\u6d4b\u6765\u8fdb\u4e00\u6b65\u8bc4\u4f30[26]\u3002<\/p>\n

\u4e09\u7ef4\u8d85\u58f0\u80fd\u591f\u5448\u73b0\u51fa\u7622\u75d5\u5904\u598a\u5a20\u56ca\u7684\u7acb\u4f53\u56fe\u50cf\u3001\u51c6\u786e\u4f4d\u7f6e\u53ca\u4e0e\u7622\u75d5\u7684\u5173\u7cfb\uff0c\u8fd8\u53ef\u6e05\u6670\u663e\u793a\u524d\u58c1\u7622\u75d5\u5904\u808c\u5c42\u539a\u5ea6\u53ca\u5b50\u5bab\u8180\u80f1\u754c\u9762\uff0c\u4ece\u800c\u6709\u52a9\u4e8e\u63d0\u9ad8\u65e9\u671f\u80ce\u76d8\u690d\u5165\u7684\u68c0\u51fa\u7387[27]\u3002\u56e0\u6b64\uff0c\u4e09\u7ef4\u8d85\u58f0\u662f\u4e8c\u7ef4\u8d85\u58f0\u7684\u6709\u6548\u8865\u5145\u624b\u6bb5\uff0c\u6709\u52a9\u4e8e\u63d0\u9ad8CSP\u8bca\u65ad\u7684\u51c6\u786e\u6027\u3002\u4f46\u76ee\u524d\u5c1a\u4e0d\u5efa\u8bae\u5c06\u4e09\u7ef4\u8d85\u58f0\u4f5c\u4e3aCSP\u7684\u5e38\u89c4\u68c0\u67e5 [1]\u3002<\/p>\n

MRI\u8f6f\u7ec4\u7ec7\u5206\u8fa8\u7387\u9ad8\uff0c\u80fd\u591f\u660e\u786e\u598a\u5a20\u56ca\u4e0e\u7622\u75d5\u7684\u5173\u7cfb\uff0c\u5ba2\u89c2\u6d4b\u91cf\u7622\u75d5\u5904\u808c\u5c42\u7684\u539a\u5ea6\uff0c\u6709\u52a9\u4e8e\u5224\u65ad\u598a\u5a20\u56ca\u4e0e\u8180\u80f1\u7684\u5173\u7cfb\uff0c\u5bf9\u4e8eCSP\u7684\u8bca\u65ad\u53ca\u5206\u578b\u5177\u6709\u91cd\u8981\u7684\u4ef7\u503c\uff0c\u662f\u8d85\u58f0\u68c0\u67e5\u7684\u91cd\u8981\u8865\u5145\u624b\u6bb5\u3002MRI\u5c24\u5176\u9002\u4e8e\u8bca\u65ad\u56f0\u96be\u6216\u8005\u9ad8\u98ce\u9669\u7c7b\u578b\u7684\u60a3\u8005\uff0c\u6709\u52a9\u4e8e\u6307\u5bfc\u6cbb\u7597\u65b9\u6848\u7684\u9009\u62e9\u3002\u4f46\u56e0MRI\u8d39\u7528\u8f83\u9ad8\uff0c\u4e14\u4e0d\u9002\u5408\u52a8\u6001\u76d1\u6d4b\uff0c\u6545\u4e0d\u63a8\u8350\u4f5c\u4e3a\u5e38\u89c4\u68c0\u67e5\u548c\u5206\u578b\u7684\u4f9d\u636e\u3002<\/p>\n

\u8840\u6e05\u03b2-hCG\u5347\u9ad8\u662f\u8bca\u65adCSP\u7684\u5fc5\u8981\u6761\u4ef6\uff0c\u5bf9\u4e8eCSP\u7684\u8bca\u65ad\u53ca\u4e25\u91cd\u7a0b\u5ea6\u5224\u65ad\u5e76\u65e0\u7279\u5f02\u6027, \u4f46\u5728\u6cbb\u7597\u540e\u968f\u8bca\u8bc4\u4f30\u4e2d\u5177\u6709\u91cd\u8981\u4ef7\u503c\u3002\u82e5\u53d1\u73b0\u8840\u03b2-hCG\u5f02\u5e38\u5347\u9ad8\u6216\u4e0b\u964d\u4e0d\u6ee1\u610f\uff0c\u9700\u8981\u8b66\u60d5\u7622\u75d5\u5904\u598a\u5a20\u6ecb\u517b\u7ec6\u80de\u75be\u75c5\u7684\u53ef\u80fd\u3002\u53e6\u5916\uff0cCSP\u8fd8\u9700\u8981\u4e0e\u5bab\u9888\u598a\u5a20\u3001\u5bab\u5185\u598a\u5a20\u96be\u514d\u6d41\u4ea7\u3001\u4e0d\u5168\u6d41\u4ea7\u3001\u5176\u4f59\u5bab\u4f53\u7622\u75d5\u90e8\u4f4d\u808c\u58c1\u95f4\u598a\u5a20\u7b49\u75be\u75c5\u8fdb\u884c\u9274\u522b\u3002<\/p>\n

\u5178\u578b\u7684\u8d85\u58f0\u8868\u73b0\u540c\u65f6\u7ed3\u5408\u5256\u5bab\u4ea7\u53f2\u3001\u8840\u03b2-hCG\u5347\u9ad8\u5373\u53ef\u8bca\u65ad\u4e3aCSP\u3002\u53ca\u65f6\u3001\u51c6\u786e\u3001\u8be6\u5b9e\u7684\u8d85\u58f0\u68c0\u67e5\u81f3\u5173\u91cd\u8981\uff0c\u6709\u52a9\u4e8e\u786e\u5b9a\u4e34\u5e8a\u5206\u578b\uff0c\u4ee5\u6307\u5bfc\u9009\u62e9\u6700\u4f73\u7684\u4e00\u7ebf\u6cbb\u7597\u65b9\u6848\u3002\u503c\u5f97\u6ce8\u610f\u7684\u662f\uff0c\u8d85\u58f0\u8bca\u65ad\u5b58\u5728\u4e00\u5b9a\u7684\u4e3b\u89c2\u6027\u548c\u5c40\u9650\u6027\uff0c\u5efa\u8bae\u7531\u7ecf\u8fc7\u4e13\u4e1a\u57f9\u8bad\u7684\u3001\u7ecf\u9a8c\u4e30\u5bcc\u7684\u5987\u79d1\u8d85\u58f0\u533b\u751f\u8fdb\u884c\u8bca\u65ad\uff0c\u5c3d\u91cf\u63d0\u9ad8\u8d85\u58f0\u8bca\u65ad\u5206\u578b\u7684\u51c6\u786e\u6027\u548c\u540c\u8d28\u5316\u3002\u5bf9\u4e8e\u6000\u7591CSP\u800c\u7ecf\u9634\u9053\u5f69\u8d85\u4e0d\u80fd\u786e\u5b9a\u8bca\u65ad\u65f6\uff0c\u5e94\u8054\u5408MRI\u68c0\u67e5\u6216\u53ca\u65f6\u8f6c\u8bca\u4ee5\u5c3d\u5feb\u660e\u786e\u8bca\u65ad\uff0c\u4ece\u800c\u907f\u514d\u56e0\u5ef6\u8fdf\u8bca\u65ad\u6216\u8bef\u8bca\u5bfc\u81f4\u4e25\u91cd\u5e76\u53d1\u75c7\u7684\u53d1\u751f\u3002<\/p>\n

5 CSP\u7684\u5206\u578b<\/h2>\n

\u8d8a\u6765\u8d8a\u591a\u7684\u7814\u7a76\u7ed3\u679c\u652f\u6301\u5bf9CSP\u8fdb\u884c\u4e34\u5e8a\u5206\u578b\uff0c\u5e76\u57fa\u4e8e\u5206\u578b\u5236\u5b9a\u4e2a\u4f53\u5316\u7684\u6700\u4f73\u6cbb\u7597\u65b9\u6848\u3002\u76ee\u524d\u62a5\u9053\u7684CSP\u4e34\u5e8a\u5206\u578b\u5747\u57fa\u4e8e\u8d85\u58f0\u68c0\u67e5\u7ed3\u679c\u30022000\u5e74Vial\u7b49[23]\u9996\u6b21\u5c06CSP\u5206\u4e3a\u5185\u751f\u578b\u4e0e\u5916\u751f\u578b\uff0c\u6b64\u5206\u578b\u65b9\u6cd5\u7b80\u5355\u6613\u64cd\u4f5c\uff0c\u5df2\u88ab\u56fd\u5185\u5916\u5b66\u8005\u5e7f\u6cdb\u5e94\u7528\u3002\u968f\u7740\u5bf9CSP\u8ba4\u77e5\u7684\u589e\u52a0\uff0cCSP\u7684\u5206\u578b\u4e5f\u5f97\u5230\u4e86\u8fdb\u4e00\u6b65\u4f18\u5316[4, 28-31]\uff0c\u7efc\u5408\u598a\u5a20\u56ca\u4f4d\u7f6e\u3001\u690d\u5165\u7622\u75d5\u5904\u808c\u5c42\u7684\u6df1\u5ea6\u3001\u5468\u56f4\u8840\u6d41\u60c5\u51b5\u53ca\u598a\u5a20\u56ca\u751f\u957f\u65b9\u5411\u8d8b\u52bf\u7b49\u6307\u6807\uff0c\u5bf9CSP\u8fdb\u884c\u4e86\u4e0d\u540c\u7684\u5206\u578b\u3002\u8fd9\u4e9b\u5206\u578b\u7cfb\u7edf\u6709\u52a9\u4e8e\u6307\u5bfc\u4e34\u5e8a\u6cbb\u7597\uff0c\u4f46\u8d85\u58f0\u8bca\u65ad\u6307\u6807\u8f83\u5bbd\u6cdb\uff0c\u4e5f\u672a\u9488\u5bf9\u6bcf\u79cd\u7c7b\u578b\u63d0\u4f9b\u6700\u4f73\u7684\u6cbb\u7597\u65b9\u5f0f\u9009\u62e9\uff0c\u6240\u4ee5\u4e0d\u80fd\u6ee1\u8db3\u4e34\u5e8a\u5b9e\u9645\u64cd\u4f5c\u9700\u8981\u3002<\/p>\n

\u5c71\u4e1c\u5927\u5b66\u9f50\u9c81\u533b\u9662\u5987\u4ea7\u79d1\u56e2\u961f\u4e8e2015\u5e74\u9996\u6b21\u63d0\u51fa\u4e86\u7622\u75d5\u598a\u5a20\u5b9e\u7528\u4e34\u5e8a\u5206\u578b\u8bca\u6cbb\u7b56\u7565(\u9f50\u9c81\u5206\u578b)[32]\u3002\u7ecf\u8fc7\u591a\u5e74\u7684\u4e34\u5e8a\u9a8c\u8bc1\uff0c\u56e2\u961f\u8fdb\u4e00\u6b65\u901a\u8fc7\u56de\u987e\u6027\u75c5\u4f8b\u5206\u6790\uff0c\u5bf9\u539f\u5206\u578b\u8fdb\u884c\u4f18\u5316\uff0c\u63d0\u51fa\u65b0\u7684\u4e34\u5e8a\u5206\u578b\u8bca\u6cbb\u7b56\u7565(\u9f50\u9c81\u5206\u578b)[6]\u3002\u6b64\u5206\u578b\u7cfb\u7edf\u57fa\u4e8e\u7ecf\u9634\u9053\u8d85\u58f0\u68c0\u67e5\uff0c\u6839\u636eCSP\u672f\u4e2d\u5927\u51fa\u8840\u7684\u72ec\u7acb\u5371\u9669\u56e0\u7d20, \u5373\u524d\u58c1\u808c\u5c42\u539a\u5ea6\u4e0e\u5b55\u56ca\/\u5305\u5757\u5927\u5c0f\u7684\u5b9a\u91cf\u503c\u8fdb\u884c\u5206\u578b\uff0c\u5e76\u9488\u5bf9\u6bcf\u79cd\u7c7b\u578b\u5206\u522b\u63a8\u8350\u4e86\u6700\u4f73\u7684\u4e00\u7ebf\u624b\u672f\u6cbb\u7597\u65b9\u6848\u3002\u4f18\u70b9\u5728\u4e8e\u53c2\u7167\u5ba2\u89c2\u6570\u636e\u8fdb\u884c\u5206\u578b\uff0c\u91cf\u5316\u6807\u51c6\uff0c\u5e76\u4f9d\u636e\u5206\u578b\u6307\u5bfc\u4e34\u5e8a\u6cbb\u7597\uff0c\u4fbf\u4e8e\u4e34\u5e8a\u533b\u5e08\u638c\u63e1\u548c\u5b9e\u9645\u64cd\u4f5c\u3002<\/p>\n

\u672c\u5171\u8bc6\u63a8\u8350\u91c7\u7528\u5b9e\u7528\u4e34\u5e8a\u5206\u578b\u6807\u51c6\u5bf9CSP\u8fdb\u884c\u5206\u578b[6], \u5206\u578b\u6807\u51c6\u53ca\u6bcf\u79cd\u7c7b\u578b\u6240\u63a8\u8350\u7684\u6700\u4f73\u4e00\u7ebf\u624b\u672f\u6cbb\u7597\u65b9\u6848\u89c1\u8868 1\uff0c\u56fe 1\u3002<\/p>\n

\u88681   \u7622\u75d5\u598a\u5a20\u5b9e\u7528\u4e34\u5e8a\u5206\u578b\u7684\u5206\u578b\u6807\u51c6\u53ca\u63a8\u8350\u7684\u9996\u9009\u624b\u672f\u65b9\u5f0f<\/p>\n

Table 1  Clinical classification of cesarean scar pregnancy and recommended optimal surgical treatment strategy<\/p>\n

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