剖宫产后子宫瘢痕妊娠异常供血的数字减影血管造影表现及相关研究  

DSA findings and related study of abnormal blood supply in cesarean scar pregnancy

作　　者：张伟[1] ZHANG Wei(Department of Iuterventioal Radiology,the First Prople's Heospital of Zheng zhou,Zhengzhou 450004,China)

机构地区：[1]郑州市第一人民医院介入科,河南郑州450004

出　　处：《实用放射学杂志》2020年第7期1117-1120,1128,共5页Journal of Practical Radiology

基　　金：河南省医学科技攻关计划联合共建项目(2018020735)。

摘　　要：目的 研究剖宫产后瘢痕妊娠(CSP)异常供血的DSA表现及相关因素.方法 收集62例接受子宫动脉栓塞术(UAE)的CSP患者的临床及DSA影像学资料,DSA影像分析采用双盲法,将妊娠囊有除子宫动脉以外的异常供血者分为A组,无异常供血者分为B组,对比2组间年龄、孕周、剖宫产次数、阴道出血、妊娠囊最大径、妊娠囊与膀胱间子宫肌层厚度及UAE术前血清β-人绒毛膜促性腺激素(HCG)的差异.结果 (1)17.7%(11/62)的患者妊娠囊有异常供血,其中左侧2例,右侧5例,双侧4例;异常供血血管来源主要为膀胱动脉(86.7%,13/15);(2)A、B 2组年龄、孕周、妊娠囊最大径的差异有统计学意义(P<0.05),其中妊娠囊最大径中3组间两两相比,≥50 mm与<30 mm组间差异有统计学意义(P<0.05),余组间差异无统计学意义(P>0.05);剖宫产次数、阴道出血、妊娠囊与膀胱间子宫肌层厚度及血清β-HCG间的差异无统计学意义(P>0.05).结论 年龄、孕周、妊娠囊最大径3项因素在CSP的UAE治疗中需要加以关注,尤其是孕周≥7,妊娠囊最大径≥50 mm的CSP患者,妊娠囊可能有异常供血,有导致UAE失败的潜在风险.Objective To study the DSA findings of abnormal blood supply in cesarean scar pregnancy(CSP) and its related factors.Methods The clinical and DSA imaging data of 62 CSP received UAE were collected,and double-blind method was performed in DSA imaging analysis.The patients with or without abnormal blood supply of gestation sac except uterine artery were divided into group A and group B,then the differences of age,gestational weeks,number of cesarean section,vaginal bleeding,maximum diameter of gestation sac,thickness of uterine muscle layer between gestation sac and bladder and serum β-HCG before UAE were compared between the two groups. Results(1)17.7%(11/62) of the patients had abnormal blood supply in the gestation sac,including 2 cases on the left side,5 caes on the right and 4 cases on the both sides.The main source of abnormal blood supply vessels was the bladder artery (86.7%,13/15).(2)There were significant diffences in age,gestational weeks and maximum diameter of gestation sac between the two groupe(P<0.05),and there was significant difference in the maximum diameter of gestation sac between≥50 mm group and<30 mm group(P<0.05),but there was no significant difference between the other groups(P >0.05),and no significant difference in the number of cesarean section,vaginal bleeding,the thickness of uterine muscle layer between gestation sac and bladder and serum β-HCG before UAE(P>0.05).Conclusion Age,gestational weeks and maximum diameter of gestation sac need to be paid attention to in UAE treatment of CSP, especially in patients with gestational age≥7 weeks and maximum diameter od gestation sac≥50 mm.Those gestation sac may have abnormal blood supply,which may lend to the potential risk of UAE failure.

关 键 词：剖宫产瘢痕妊娠 数字减影血管造影术 血液供应 异常 

分 类 号：R714.2[医药卫生—妇产科学] R814.43[医药卫生—临床医学]