Objective:To investigate the clinical characteristics of recurrent cesarean scar pregnancy(CSP and find out the risk factors for reducing the occurrence of recurrent CSP.Methods:The clinical data of 19 patients with recurrent CSP were analyzed retrospectively.The data included the maternal age,gravidity,the time of abortion,the number of cesarean section,the indications for cesarean section surgery,the surgical hospital grade,the interval between the first CSP and previous cesarean section,the interval between two CSP,and the classification(type Ⅰ,Ⅱ,Ⅲ,according to the classification standard of Chinese Medical Association in 2016),treatment method,operation time,bleeding volume,hospitalization days,presence of diverticulum after cesarean section were statistically analyzed.Results:Nineteen patients with recurrent CSP accounted for 1.53％ in the hospitalized patients with CSP at the same period.In 19 patients,only 3 patients had no the history of induced abortion or intrauterine operation;t he average number of induced abortion was(2.11 + 1.08).Among them,9 patients (47.37 ％)had 2 times or more early pregnancy abortion or medical abortion.78.95 ％ (15/19)patients did not enter the birth process during the first cesarean section and underwent elective cesarean section for various reasons.All patients were graded according to the CSP classification.The curative effects were good and all patients were cured.No adverse events were followed up.There was no statistical differences in uterine artery embolization rate,the operation time,the intraoperative blood loss and the hospitalization days between the two CSP(P＞0.05).The interval between two CSP was 3-60 months,of them 9 patients were within 12 months.The incision diverticulum existed in both two CSP cesarean sections.Conclusions:Repeated abortion history,elective cesarean section without indications,and presence of incision diverticulum after cesarean section are the high risk factors for recurrent CSP.However,its specific mechanism still needs further research and discussion.%目的 探讨复发性剖宫产瘢痕妊娠(CSP)的临床病例特点,以期给出适宜的临床建议,减少复发性CSP的发生.方法 回顾性分析19例复发性CSP患者的临床资料,包括:患者的年龄、孕次、流产次数、剖宫产次数、剖宫产手术指征、手术医院级别,以及初次CSP距离前次剖宫产时间、两次CSP间隔时间、CSP分型(Ⅰ、Ⅱ、Ⅲ型)、两次CSP的治疗方法、手术时间、手术出血量、住院天数,是否存在切口憩室等,并对数据进行统计学分析.结果 19例复发性CSP发生率约占同期收治CSP患者的1.53％;19例患者中仅有3例无人工流产、宫腔操作史;人流次数平均(2.11±1.08)次,其中9例(47.37％)患者有2次及以上早孕人流、药流史.78.95％(15/19)的患者行第一次剖宫产时未进入产程,因各种原因行择期剖宫产.所有患者根据CSP分型进行分级治疗,效果佳,均治愈,随访无不良事件发生;两次CSP的子宫动脉栓塞率、手术时间、手术出血比较差异均无统计学意义(P＞0.05).两次CSP间隔时间3～60个月,间隔12个月内的9例.两次CSP均存在剖宫产切口憩室.结论 多次人工流产史、无指征的择期剖宫产术、剖宫产切口憩室的存在可能是复发性CSP发生的相关因素,但其具体机制仍需进一步研究探讨.
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