剖宫产瘢痕妊娠刮宫术后再入院治疗的影响因素分析  

Analysis of the influencing factors of readmission treatment after curettage in women with cesarean scar pregnancy

作　　者：张艳[1] 徐晓慧[1] 王君[1] 宋涛[1] ZHANG Yan;XU Xiaohui;WANG Jun;SONG Tao(Department of Gynecology of Weifang Maternity and Child Care Hospital,Shandong Weifang 261011,China)

机构地区：[1]潍坊市妇幼保健院妇产科,山东潍坊261011

出　　处：《中国妇幼健康研究》2021年第6期868-872,共5页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨剖宫产瘢痕妊娠患者初次刮宫后再入院治疗的影响因素。方法共收集潍坊市妇幼保健院2016年1月至2020年1月收治的225例确诊为剖宫产瘢痕妊娠(CSP)并行刮宫术患者的临床资料。刮宫术后重新入院的CSP患者45例,设为再入院组;再入院组的每例病例,选择4例同期确诊为CSP刮宫术后没有组织残留的患者作为对照组,共180例。比较两组的年龄、孕周、孕次、孕囊大小、瘢痕处肌层厚度、术前血人绒毛膜促性腺激素(hCG)水平、术后血hCG下降率、子宫动脉栓塞的预防使用率、术中出血量等因素,并筛选相关危险因素。结果再入院组与对照组的孕周、孕囊最大直径、瘢痕处肌层厚度、术后血hCG下降速率比较,差异均有统计学意义(t/χ2值分别为9.386、4.126、7.266、4.391,P<0.05)。Logistics回归分析结果显示,孕囊(OR=1.481,95%CI:1.281~2.645)、瘢痕处肌层厚度(OR=1.426,95%CI:1.165~4.823)、血hCG(OR=1.693,95%CI:1.147~2.896)是影响CSP初次刮宫术后重新入院治疗的独立危险因素(P<0.05)。孕囊最大直径为2.75cm、瘢痕处肌层厚2.95cm、血hCG下降速率62.50%时,对CSP刮宫术后组织残留的预测值最佳。结论孕囊、瘢痕处肌层厚度、血hCG下降速率是影响CSP刮宫术后再次入院治疗的独立危险因素。对于孕囊最大直径≥2.75cm、瘢痕处肌层厚度≤2.95cm、血hCG下降速率≤62.50%的CSP患者,日常工作中应予以重视,必要时适当给予干预,从而减少CSP患者再次入院治疗的发生率。Objective To assess the influence factors of readmission treatment after curettage in women with cesarean scar pregnancy(CSP).Methods The clinical data of 225 patients diagnosed with CSP and undergoing curettage were collected from Weifang Maternal and Child Health Hospital from January 2016 to January 2020.There were 45 cases of rehospitalization after curettage(readmission group).For each case, 4 patients without tissue residue after curettage who were diagnosed with CSP during the same period were selected as the control group(n=180).The maternal age, gestational grade, pregnant bursa size, muscular layer thickness at the scar, preoperative blood human chorionic gonadotropin(hCG) levels, descent rates of postoperative blood hCG,prophylactic rates of uterine artery embolization, intraoperative blood loss and other factors were compared between the two groups, and related risk factors were screened.Results There were statistically significant differences in gestational age, pregnant bursa sizes, muscular layer thickness at the scar, and descent rates of hCG in blood between the control group and the readmission group(t/χ2 values were 9.386,4.126,7.266 and 4.391,respectively, all P<0.05).Multivariate logistic regression analysis results showed that pregnant bursa size(OR=1.481,95%CI:1.281-2.645),muscular layer thickness at the scar(OR=1.426,95%CI:1.165-4.823),and descent rates of hCG(OR=1.693,95%CI:1.147-2.896) were independent risk factors for readmission treatment after curettage of CSP(all P<0.05).When the maximum diameter of pregnant bursa was 2.75 cm, the thickness of the muscular layer at the scar was 2.95 cm, and the descent rate of blood HCG was 62.50%,the predictive value of tissue residual after curettage for women with CSP was best.Conclusion The pregnant bursa size, the thickness of the muscular layer at the scar and descent rate of hCG are independent risk factors for readmission treatment after curettage of caesarean scar pregnancy.For CSP patients with the maximum diameter of the gestational capsu

关 键 词：剖宫产瘢痕妊娠 刮宫术 再入院治疗 独立危险因素 

分 类 号：R714.22[医药卫生—妇产科学]