影响剖宫产瘢痕妊娠治疗效果的危险因素分析  

Analysis of risk factors influencing the therapeutic effect of cesarean scar pregnancy

作　　者：陈竺 谭廷廷 孙秋蕾 池睿 管雪 熊希 罗莉 高春燕 陈正琼 应德美 CHEN Zhu;TAN Tingting;SUN Qiulei;CHI Rui;GUAN Xue;XIONG Xi;LUO Li;GAO Chunyan;CHEN Zhengqiong;YING Demei(Department of Obstetrics and Gynecology,Second Affiliated Hospital,Army Military Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院妇产科,重庆400037

出　　处：《介入放射学杂志》2021年第10期1048-1052,共5页Journal of Interventional Radiology

基　　金：重庆市科技局技术创新与应用发展专项面上项目(cstc2019jscx-msxmX0269);重庆市科卫联合医学科研项目面上项目(2019MSXM025)。

摘　　要：目的探讨剖宫产瘢痕妊娠(CSP)患者经子宫动脉栓塞术(UAE)治疗后形成混合性包块的经阴道彩色超声影像学特征,为评估CSP严重程度提供依据。方法回顾性分析2015年1月至2016年1月在陆军军医大学第二附属医院接受经导管双侧UAE联合清宫术治疗的182例CSP患者临床和经阴道彩色超声影像学资料。根据治疗后瘢痕部位是否出现混合性包块分为瘢痕部位形成混合性包块组和未形成包块组,比较两组患者临床和经阴道彩色超声影像学特征。结果 UAE联合清宫术治疗后128例(70.3%)患者痊愈(未形成包块),54例(29.7%)形成混合性包块,其中7例再次接受腹腔镜下病灶切除术。单因素分析发现,两组患者孕龄、术前血清β-人绒毛膜促性腺激素(HCG)、胎心、孕囊周围血流分级、妊娠包块最大径线、孕囊类型、子宫下段肌层厚度差异均有统计学意义(P<0.001)。多变量logistic回归分析显示,孕囊周围血流分级Ⅲ级、有胎心、妊娠包块最大径线>25 mm、子宫下段肌层厚度<1.5 mm是CSP治疗后形成混合性包块的危险因素。结论孕囊周围血流分级Ⅲ级、有胎心、妊娠包块最大径线>25 mm、子宫下段肌层厚度<1.5 mm均为影响CSP患者UAE治疗效果的高危因素。Objective To investigate the transvaginal color ultrasonographic characteristics of the mixed mass, which is formed in delivery women with cesarean scar pregnancy(CSP) after uterine artery embolization(UAE) together with curettage treatment, and to provide basic reference for the evaluation of its degree of severity. Methods The clinical data and transvaginal color ultrasonographic materials of 182 CSP patients,who received transcatheter bilateral UAE together with curettage treatment at the Second Affiliated Hospital of Army Military Medical University of China between January 2015 and January 2016, were retrospectively collected. According to whether the mixed mass was formed at the scar site after treatment, the patients were divided into mass formation group and non-mass formation group. The clinical features and transvaginal color ultrasonographic findings were compared between the two groups. Results After UAE together with curettage treatment, 128 patients(70.3%) recovered with no formation of mass, and 54 patients(29.7%) developed a mixed mass at the scar site, of them 7 patients had to receive laparoscopic resection of lesion. Univariate analysis showed that statistically significant differences in gestational age, preoperative serum β-HCG level, fetal heart,grading of blood flow around the gestational sac, maximum diameter of pregnancy mass, type of gestational sac, muscle layer thickness of lower uterus existed between the two groups(P<0.001). Multivariate logistic regression analysis revealed that blood flow around the gestational sac of grade Ⅲ, presence of fetal heart, the maximum diameter of pregnancy mass>25 mm, and muscle layer thickness of lower uterus<1.5 mm were the risk factors for the formation of mixed mass in CSP patients after treatment. Conclusion The blood flow around the gestational sac of grade Ⅲ, presence of fetal heart, the maximum diameter of pregnancy mass >25 mm and the muscle layer thickness of lower uterus <1.5 mm are high-risk factors affecting the curative effect of UAE

关 键 词：剖宫产瘢痕妊娠 经阴道彩色超声 子宫动脉栓塞术 危险因素 

分 类 号：R714.2[医药卫生—妇产科学]