宫腔镜治疗剖宫产术后子宫瘢痕妊娠效果的回顾性研究  

Retrospective Study of Hysteroscopic Treatment of Uterine ScaRPregnancy AfteRCesarean Section.

作　　者：杨兰英 王嘉霞 符玉明 吴桐 Yang Lanying;Wang Jiaxia;Fu Yuming(Gynecology Department of Chengdu Western Hospital,Chengdu,Sichuan 614000,China.)

机构地区：[1]成都西区医院妇科,四川成都614000

出　　处：《四川医学》2021年第9期943-947,共5页Sichuan Medical Journal

摘　　要：目的回顾性分析宫腔镜治疗剖宫产术后子宫瘢痕妊娠(CSP)的效果。方法选取204例行宫腔镜治疗CSP患者,根据宫腔镜手术效果,分为宫腔镜术成功组和宫腔镜术失败组,分析宫腔镜术失败的影响因素。结果成功组在剖宫产次数、孕周、β-hCG、距离上次剖宫产时间、孕囊直径、子宫瘢痕处肌层厚度、PSV、RI与失败组对比,差异有统计学意义(P<0.05)。受试者工作特征曲线确定孕周、β-hCG、孕囊直径、子宫瘢痕处肌层厚度、PSV、RI的临界分类点分别为53 d、31659 mU/ml、3.3 cm、0.29 cm、57.3 cm/s、0.385。经二分类Logistic回归分析,剖宫产史(2次)、孕周>53 d、β-hCG>31659 mU/ml、孕囊直径>3.3 cm、PSV>57.3 cm/s、RI≤0.385是宫腔镜治疗CSP失败的危险因素(P<0.05);距离上次剖宫产时间≥5年、子宫瘢痕处肌层厚度>0.29 cm是宫腔镜治疗CSP失败的保护因素(P<0.05)。结论剖宫产史(2次)、孕周>53 d、β-hCG>31659 mU/ml、孕囊直径>3.3 cm、PSV>57.3 cm/s、RI≤0.385时,宫腔镜治疗CSP失败的风险高,而距离上次剖宫产时间≥5年、子宫瘢痕处肌层厚度>0.29 cm时,宫腔镜治疗CSP失败的风险低。Objective To retrospectively analyze the effect of hysteroscopy in the treatment of scar pregnancy(CSP)after cesarean section.Methods A total of 204 CSP patients undergoing hysteroscopy were selected.According to the effect of hysteroscopy,the patients were divided into successful group and failure group,and the influence factors of failure of hysteroscopy were analyzed.Results Compared with the failure group,the number of cesarean section,gestational age,β-hCG,interval time from last cesarean section,gestational sac diameter,muscular thickness of uterine scar,PSV,RI showed statistically significant differences in the successful group(P<0.05).The receiver operating characteristic curve determined that the critical classification points of gestational age,β-hCG,gestational sac diameter,uterine scar muscle thickness,PSV,and RI were 53 days,31659 mU/ml,3.3 cm,0.29 cm,and 57.3 cm/s,0.385 respectively.After the binary logistic regression analysis,the history of cesarean section(2 times),gestational age>53 days,β-hCG>31659 mU/ml,gestational sac diameter>3.3 cm,PSV>57.3 cm/s,RI≤0.385 were the risk factors for the failure of endoscopic treatment of CSP(P<0.05);the interval time since the last cesarean section≥5 years,and the thickness of the muscle layer at the uterine scar>0.29 cm were the protective factors for the failure of hysteroscopy in the treatment of CSP(P<0.05).Conclusion Cesarean section(twice),gestational weeks>53 days,β-hCG>31659 mU/ml,gestational capsule diameter>3.3 cm,PSV>57.3 cm/s,RI≤0.385,are the risk factors of failure of hysteroscopic CSP,while the interval time from the last cesarean section≥5 years,and the thickness of muscular layer at uterine scar>0.29 cm decrease the risk of failure of hysteroscopic treatment of CSP.

关 键 词：宫腔镜术 剖宫产术后子宫瘢痕妊娠 Β-绒毛膜促性腺激素 动脉收缩期峰值血流速度 动脉血管阻力指数 回顾性研究 

分 类 号：R711.74[医药卫生—妇产科学]