子宫动脉栓塞术联合清宫术治疗剖宫产瘢痕妊娠大量阴道出血的影响因素分析  

Analysis of risk factors of massive vaginal bleeding during uterine artery embolization combined with curettage for the treatment of a caesarean scar pregnancy

作　　者：阿斯燕.努斯拉提 林开清[1] 林俊[1] 

机构地区：[1]浙江大学医学院附属妇产科医院,杭州310006

出　　处：《中国计划生育学杂志》2016年第12期828-831,共4页Chinese Journal of Family Planning

摘　　要：目的:分析子宫动脉栓塞术(UAE)联合清宫术在治疗剖宫产疤痕妊娠(CSP)中导致大量阴道出血的高危因素。方法:收集本院行UAE联合清宫术治疗的576例CSP患者的临床资料,以术后24h内出血是否≥500 ml分两组。结果:单因素分析显示,两组孕周、孕周>8周比例、包块最大直径、包块最大直径>6cm比例、孕囊距浆膜层的肌层厚度之间差异有统计学意义(P<0.05);logistic分析显示:孕周>8周,包块>6cm是独立危险因素(P<0.05)。结论:对于包块>6cm,孕周>8周患者应充分告知出血风险,加强围手术期管理,清宫术前再次超声检查了解孕囊着床处血流情况,尤其是局部血流仍较丰富的状况与术中大量出血的相关性应予以关注。做好充分准备,避免严重并发症的发生。Objective.. To analyze the risk factors of massive vaginal bleeding during uterine artery embolization （UAE） combined with curettage for treating caesarean scar pregnancy （CSP）. Method： Clinical data of 576 cases with CSP treated by UAE combined with curettage were collected, and all the cases were divided into two groups, which was group A （blood loss〈500 ml） and group B （blood loss≥500 ml）.Result.. Univariate analysis showed that ＂there were significant difference between the two groups in the proportion of gestational week〉8, diameter mass of CSP〉6 cm, myometrial thickness anterior to the CSP （P〈0.05）. Logistic analysis showed that gestational week〉8 or the diame- ter of CSP mass〉6 cm was independent risk factors for hemorrhage （P〈0.05）. Conclusion.. Patients with CSP should be fully informed bleeding risk, strengthen the perioperative management. Knowing the bleeding situation of gestational sac implantation by ultrasound before operation is very important, especially the relatively situation of local abundant blood flow. And intraoperative bleeding should be paid more attention to. Fully prepared before operation maybe avoid severe complications.

关 键 词：剖宫产瘢痕妊娠 子宫动脉栓塞术 清宫术 阴道出血 

分 类 号：R714.22[医药卫生—妇产科学]