瘢痕妊娠患者预防性子宫动脉栓塞术中侧支血管残留与刮宫术中出血的关系  

Relationship between residual collateral vessels in preventive uterine arterial embolization and the risk of bleeding during the operation of curettage for cesarean scar pregnancy

作　　者：李继军[1] 孙逢成 张垒[1] 张国栋[1] 孙增涛[1] Li Jijun;Sun Fengcheng;Zhang Lei;Zhang Guodong;Sun Zengtao(Shandong Provincial Medical Imaging Institute Affiliated to Shandong University,Jinan 250021,China;Department of Radiology,Jinan Traditional Chinese Medicine Hospital,Jinan 271100,China)

机构地区：[1]山东大学附属山东省医学影像学研究所,济南250021 [2]济南中西医结合医院放射科,271100

出　　处：《中华放射学杂志》2020年第11期1107-1111,共5页Chinese Journal of Radiology

基　　金：山东省科技发展计划项目(2013GSF11907)。

摘　　要：目的探讨剖宫产术后瘢痕妊娠患者行子宫动脉栓塞术后,残余侧支血管与刮宫术中出血风险的关系。方法回顾性收集2012年1月至2019年6月山东省立医院499例瘢痕妊娠患者资料,均于刮宫术前行预防性子宫动脉栓塞术。术中发现子宫侧支血管的患者尽可能栓塞侧支血管。根据栓塞结束时子宫体中下部残余染色浓度由低到高分为A、B、C 3类,A类无染色或轻度染色,B类中度染色,C类明显染色。记录患者刮宫术中出血量,计算3类患者刮宫术中小量出血(<50 ml)和大出血(>500 ml)发生率,并采用χ²检验或Fisher确切概率法分别与对照组(无子宫侧支血管患者)比较。结果53例患者存在侧支血管,栓塞后A、B、C类患者分别为25、15、13例,行侧支血管栓塞36例。B、C类患者刮宫术中小量出血发生率[60.0%(9/15)和46.2%(6/13)]低于对照组(87.9%,392/446),差异有统计学意义(χ^²=9.972,P=0.002;χ^²=19.090,P<0.001);C类患者大出血发生率(23.1%,3/13)明显高于对照组(2.2%,9/446),差异有统计学意义(χ^²=14.480,P=0.001)。结论存在子宫侧支血管的瘢痕妊娠患者,栓塞侧支血管可减少刮宫术中出血量,子宫体中下部残余染色对预测刮宫术中大出血风险有意义。Objective To explore the relationship between residual collateral vessels in uterine arterial embolization(UAE)and the risk of bleeding during the operation of curettage for cesarean scar pregnancy.Methods A total of 499 patients who underwent preventive UAE before curettage for scar pregnancy in Shandong Provincial Hospital from January 2012 to June 2019 were included.Clinical data of the patients were retrospectively collected and analyzed.In patients with uterine collateral circulation,collateral vessels were embolized as much as possible.Angiography was performed after UAE.All the cases were divided into 3 grades according to residual staining in middle and lower part of corpus uteri as follows,grade A:no or mild staining,grade B:moderate staining,grade C:intense staining.Blood loss of the patients during curettage was recorded,and the incidence rate of minor hemorrhage(<50 ml)and massive hemorrhage(>500 ml)of the 3 grades were calculated respectively.The results of three grades groups were compared with those of control group(patients without collateral circulation)by using Chi-square test or Fischer exact probability.Results According to angiogram acquired after UAE,collateral vessels were found in 53 patients,with 25 cases in grade A group,15 cases in grade B group,and 13 cases in grade C group,respectively.Thirty-six patients underwent transcatheter embolization of collateral vessels.The incidence rate of minor hemorrhage in type B and C[60.0%(9/15),46.2%(6/13)]was lower than that in control group(87.9%,392/446),with significant difference found(χ²=9.972,P=0.002,χ²=19.090,P<0.001).Significant difference was found in the incidence rate of massive haemorrhage between group C(23.1%,3/13)and control group(2.2%,9/446)(χ²=14.480,P=0.001).Conclusion As for cesarean scar pregnancy cases with uterine collateral vessels,embolization of collateral vessels may reduce the amounts of bleeding during curettage.Residual staining of middle and lower part of corpus uteri may be helpful in predicting the risk of massi

关 键 词：子宫动脉栓塞术 瘢痕妊娠 侧支血管 出血 

分 类 号：R714.22[医药卫生—妇产科学]