剖宫产瘢痕妊娠患者经子宫动脉栓塞化疗联合清宫术治疗后再妊娠临床分析  

Reproductive outcomes of women with cesarean scar pregnancy after uterine artery chemoembolization combined with evacuation

作　　者：谭廷廷 孙秋蕾 罗莉 熊希 项锦红 颜苹 高春燕 陈正琼 TAN Tingting;SUN Qiulei;LUO Li;XIONG Xi;XIANG Jinhong;YAN Ping;GAO Chunyan;CHEN Zhengqiong(Department of Obstetrics and Gynecology, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院妇产科

出　　处：《第三军医大学学报》2019年第17期1672-1676,共5页Journal of Third Military Medical University

基　　金：重庆市科卫联合重点项目(2018ZDXM034);陆军军医大学第二附属医院临床科研课题(2016YLC28)~~

摘　　要：目的回顾性分析子宫动脉栓塞化疗(uterine artery chemoembolization,UACE)联合清宫术治疗后,剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)患者再次妊娠情况,探索复发性剖宫产瘢痕妊娠(recurrent cesarean scar pregnancy, RCSP)发病的影响因素。方法收集2010年1月至2017年12月于我院诊断为CSP并接受UACE联合清宫术治疗的患者病例资料及随访信息,分析其再次妊娠情况,并对比正常宫内妊娠和RCSP的临床和超声影像学特点。结果有随访资料的396例患者中,118例(29.8%)术后有妊娠计划,96例成功妊娠,妊娠次数104次(88.1%);其中正常妊娠生产62人次(59.6%),RCSP 26人次(25.0%)。278例(70.2%)患者术后无妊娠计划,42例患者再次妊娠,妊娠次数47人次(16.9%);其中正常妊娠生产2人次(4.3%),RCSP 6人次(12.7%)。在所有妊娠中,RCSP的发生率达21.2%(32/151)。RCSP组患者流产次数较正常宫内妊娠组多(P=0.029),前次CSP妊娠孕龄较正常宫内妊娠组大(P=0.020),子宫下段剩余肌层厚度较正常宫内组薄(P=0.010)。结论 CSP患者经UACE联合清宫术治疗后可再次妊娠。CSP术后再次妊娠易形成RCSP。患者流产次数、前次CSP孕龄和子宫下段剩余肌层厚度与RCSP发生相关。Objective To retrospectively analyze the reproductive outcome of patients after undergoing uterine artery chemoembolization(UACE) due to cesarean scar pregnancy(CSP), and to explore the risk factors for CSP. Methods The clinical data and follow-up information were retrospectively collected from the women who had diagnosed with CSPs and treated by UACE combined with evacuation in our hospital between January 2010 and December 2017. Their conditions of pregnancy and reproductive outcome were analyzed. The clinical manifestations and ultrasonographic features were compared between these pregnant women and those with normal pregnancy. Results Of the 396 cases with follow-up data, 118 cases(29.8%) wished to give a birth again and finally 96 cases(88.1%) were successfully pregnant, with a total of 104 pregnancies. Among them, 62 pregnancies(59.6%) were intrauterine pregnancy while 26 pregnancies(25.0%) were RCSP. Although 278 cases(70.2%) had no pregnancy plans, there were 42 cases(16.9%) having subsequent pregnancies, with a total of 47 pregnancies. Among them, 2 pregnancies(4.3%) were intrauterine pregnancy while 6 pregnancies(12.7%) were RCSP. In all pregnancies, the incidence of RCSP was 21.2%(32/151). Between the intrauterine pregnancy and RCSP groups, the latter group had older gestational age(P=0.020), thinner remnant myometrial thickness of lower uterine segment of previous CSP(P=0.010) and larger times of abortion(P=0.029). Conclusion Women with CSP could be pregnant again after UACE combined with evacuation. It is apt to form RCSP in the subsequent pregnancy after the previous CSP. The gestational age and the remnant myometrial thickness of lower uterine segment of the previous CSP and the number of abortions are associated with RCSP.

关 键 词：剖宫产瘢痕妊娠 子宫动脉栓塞化疗 再次妊娠 复发性剖宫产瘢痕妊娠 

分 类 号：R619.6[医药卫生—外科学] R714.1[医药卫生—临床医学]