【摘要】 目的 既往剖宫产瘢痕妊娠（CSP）手术治疗的研究主要围绕传统刮宫术，近年来宫腔镜下瘢痕部位妊娠病灶切除术逐渐成为CSP治疗的重要方式，但仍面临胚物残留风险。该研究旨在综合多维度客观指标，探讨CSP宫腔镜术后胚物残留的危险因素。方法 回顾性纳入2014年1月至2024年10月于北京大学第三医院妇产科诊断为CSP并采取宫腔镜手术治疗的1022例患者，将术后胚物残留者作为研究组、无残留者作为对照组，比较两组在病史、临床表现、实验室和影像学检查等多方面的差异。结果 CSP宫腔镜术后胚物残留的总体发生率为4.0%(41/1022)。单因素分析提示患者年龄、子宫位置、孕产次、剖宫产次数、既往CSP病史、既往宫腔手术史、该次CSP孕龄、胎心搏动征及术前临床症状（腹痛/阴道流血）等因素均与术后胚物残留无直接相关性（P>0.05）。在纳入交互作用分析后，多因素logistic回归分析结果提示，孕囊平均直径≥15mm且磁共振测定子宫下段瘢痕处残余肌层厚度<2.5mm(OR=4.262,95%CI 2.179～8.337,P<0.001)是胚物残留的独立危险因素。结论 CSP宫腔镜术后胚物残留与孕囊直径及子宫下段瘢痕处残余肌层厚度密切相关。CSP患者采取宫腔镜手术治疗前应全面综合评估、严格把握适应证，早发现、早干预是降低胚物残留发生率的重要方式。更多还原

【Abstract】 ObjectivePrevious studies on the surgical treatment of cesarean scar pregnancy(CSP)have primarily focused on traditional dilation and curettage. In recent years,hysteroscopic resection of the scar site pregnancy lesion has gradually become an important method for CSP treatment,but it still faces the risk of retained products of conception(RPOC). This study aims to explore the risk factors associated with RPOC after hysteroscopic surgery for CSP by integrating multi-dimensional objective indicators.MethodsA retrospective analysis was conducted in 1022 patients diagnosed with CSP and treated with hysteroscopic surgery at the Obstetrics and Gynecology Department of Peking University Third Hospital from January 2014 to October 2024. Patients with postoperative RPOC were included as the study group,and those without RPOC as the control group. Differences in medical history,clinical manifestations,laboratory and imaging examinations,and other aspects were compared between the two groups.ResultsThe overall incidence of RPOC after hysteroscopic surgery for CSP was 4.0%(41/1022). Univariate analysis indicated that patient’s age,uterine position,gravidity and parity,number of cesarean sections,history of CSP,history of intrauterine surgery,gestational age at this CSP diagnosis,presence of fetal heart activity,and preoperative clinical symptoms(abdominal pain/vaginal bleeding) were not directly related to postoperative RPOC(all P>0.05). After incorporating interaction analysis, multivariate logistic regression analysis revealed that a mean gestational sac diameter≥15 mm and a residual myometrial thickness <2.5 mm at the lower uterine segment scar site measured by magnetic resonance imaging(OR=4.262,95% CI 2.179-8.337,P<0.001)were independent risk factors for RPOC.ConclusionsRPOC after hysteroscopic surgery for CSP is closely related to the diameter of the gestational sac and the residual myometrial thickness at the lower uterine segment scar site. A comprehensive assessment and strict indication control should be conducted before CSP patients undergo hysteroscopic surgery. Early detection and early intervention are important ways to reduce the incidence of RPOC.更多还原