高危型剖宫产瘢痕妊娠相关因素分析  

Analysis on related factors of high risk-cesarean scar pregnancy

作　　者：宋永红[1] 常青[1] 陈诚[1] 李宇迪[1] 王琰[2] 郭燕丽[2] 严小丽[1] 刘小艳[1] 

机构地区：[1]第三军医大学西南医院妇产科,重庆400038 [2]第三军医大学西南医院超声科,重庆400038

出　　处：《第三军医大学学报》2016年第10期1133-1138,共6页Journal of Third Military Medical University

基　　金：重庆市科技攻关项目(CSTC2012gg-yyjs10056)~~

摘　　要：目的探讨高危型剖宫产瘢痕妊娠（high risk-cesarean scar pregnancy,HR-CSP）影响其治疗结局的危险因素。方法采用回顾性病例对照研究方法,收集2008年3月至2014年12月近7年第三军医大学西南医院妇科住院且腹腔镜下成功治疗剖宫产瘢痕妊娠（cesarean scar pregnancy,CSP）患者105例,其中30例行腹腔镜病灶清除术为高危组,75例行腹腔镜监视下清宫术为低危组。提取所有出院病历中与研究相关的患者基本资料及手术记录。采用SPSS 17.0统计软件进行分析,确定高危型CSP的独立危险因素、相对危险度（odds ratio,OR）及95%可信区间（95%confidence interval,95%CI）。结果高危组与低危组停经时间（t=-4.485,P〈0.01）、超声测量病灶最大径线（t=-5.096,P〈0.01）、手术时间（t=-11.888,P〈0.01）、术中出血量（t=-5.110,P〈0.01）、住院天数（t=-3.290,P=0.001,P〈0.05）、超声分型：孕囊型/包块型（χ2=35.188,P〈0.01）、胎血管搏动：有/无（χ^2=5.392,P=0.020,P〈0.05）差异有统计学意义;超声测量病灶最大径线（OR=1.042,95%CI：1.001-1.085）、超声分型：孕囊型/包块型（OR=14.122,95%CI：3.277-60.860）为高危型CSP发生的独立危险因素。结论剖宫产瘢痕妊娠时超声测量病灶最大径线及超声类型是影响剖宫产切口瘢痕妊娠治疗结局的独立危险因素。Objective To analyze high risk-cesarean scar pregnancy（ HR-CSP） related factors which have effect on clinical outcome. Methods With a case-control study,30 hospitalized patients for high risk group undergoing the treatment of local excision by laparoscopy and 75 patients for low risk group undergoing the treatment of dilation curettage conducted by laparoscopy were selected from our department of obstetrics and gynecology,during March 2008 and December 2014. The data were extracted from the hospital medical records,and related factors of HR-CSP were identified by univariate analysis and logistic regression analysis with software SPSS17. 0. Results Student＇s t test analysis of continuous variables showed that gestational age at diagnosis（ t =- 4. 485,P〈 0. 01）,maximum diameter of lesion by ultrasonic measurement（ t =- 5.096,P〈 0. 01）,operation time（ t =- 11. 888,P〈 0. 01）,intraoperative bleeding amount（ t =- 5. 110,P〈 0. 01） and hospitalization days（ t =- 3. 290,P = 0. 01,P〈 0. 05） were HR-CSP related factors. The Chisquared test of binary variables showed that ultrasonograghic pattern： mass-type / gestational sac-type（ Chi square = 35. 188,P〈 0. 01）,and cardiac activity in gestational sac： yes / no（ Chi square = 5. 392,P =0. 020,P〈 0. 05） also were the related factors. Logistic regression analysis showed that the maximum diameter of lesion by ultrasonic measurement（ OR = 0. 983,95% CI： 0. 970- 0. 997） and ultrasonograghic pattern： mass-type / gestational sac-type（ OR = 35. 937,95% CI： 15. 264- 84. 611） were independent risk factors of HR-CSP. Conclusions The maximum diameter of lesion by ultrasonic measurement and ultrasonograghic pattern are two independent risk factors of HR-CSP.

关 键 词：高危型剖宫产 瘢痕妊娠 病例对照研究 

分 类 号：R181.32[医药卫生—流行病学] R619.6[医药卫生—公共卫生与预防医学]