剖宫产瘢痕妊娠保守治疗的相关危险因素Meta分析  

Meta- Analysis on the Risk Factors for Cesarean Scar Pregnancy

作　　者：宋永红[1] 常青[1] 陈诚[1] 李宇迪[1] 刘小艳[1] 

机构地区：[1]第三军医大学第一附属医院,重庆400038

出　　处：《实用妇产科杂志》2015年第1期64-70,共7页Journal of Practical Obstetrics and Gynecology

基　　金：重庆市科技攻关项目(编号:cstc2012gg-yyjs10056)

摘　　要：目的：对剖宫产瘢痕妊娠（CSP）保守治疗的相关危险因素进行系统评价。方法：计算机检索Pubmed、Embase、Google、中国知网、维普、万方数据库,并辅以手工检索,检索时限2000~2013年,纳入研究的CSP为保守治疗失败的患者,其相关危险因素包括超声检查分型、胎血管搏动、治疗前血β-HCG值、年龄、孕周。采用Rev Man 5.0软件对纳入文献的数据进行Meta分析,计算相关危险因素的比值比（OR）及95%可信区间（CI）。结果：共筛选出相关文献8篇,中文文献2篇,英文文献6篇。保守治疗患者254例,失败82例,全部入选患者保守治疗失败率32.28%。Meta分析结果显示：包块型CSP（Z=3.46,OR=0.19,95%CI 0.07~0.48,P=0.0005）为保守治疗失败的危险因素,而高龄孕产妇、治疗前可探及胎血管搏动、血β-HCG值〉20000 U/L及孕周≥8周为CSP保守治疗失败的不确定因素（P〉0.05）。结论：包块型CSP显著增加治疗过程中严重并发症的发生而导致保守治疗失败,建议对CSP患者治疗前行超声检测评估分型,以避免严重并发症的发生。Objective： This systematic review and Meta-analysis evaluates evidence for risk factors associated with failed treatment of caserean scar pregnancy（ CSP） by methotrexate（ MTX） and dilation and suction curettage（ DC）. Methods： Online scientific literature databases（ all English language and Chinese language） were searched using a strategy which identified observational trials,published between January 2000 and December2013,which evaluated five risk factors for failed treatment of CSP by MTX and dilation and suction curettage（ DC）,including ultrasonographic pattern,fetal heartbeat,blood β-HCG level,maternal age,gestational age. Data was analyzed by Rev Man 5. 0 software. Fixed effect meta ananlysis model was adopted to calculate the combined odds ratio（ OR） and 95% confidence interval. Results： 8 studies involving 254 cases of conservative treatment and 82 failed cases were included. Among which 2 papers published in China and 6 papers in foreign countries. The ultrasonographic pattern of deep villi implantation as a mass is an important risk factor for failed treatment of CSP by conservative treatment. While advanced maternal age,fetal heartbeat,high blood β-HCG level,large gestational age may serve as uncertain risk factors for failed treatment of CSP by conservative treatment.Conclusions： The CSP ultrasonographic pattern of deep villi implantation as a high risk for failed treatment of CSP by conservative treatment. To avoid serious complications,we should identify the ultrasonographic pattern before conservative therapy.

关 键 词：瘢痕妊娠 保守治疗 危险因素 META分析 

分 类 号：R714.22[医药卫生—妇产科学]