早期剖宫产切口部妊娠患者侧支供血的影响因素分析  

Effect factors of collateral blood supply of patients with early trimester cesarean scar pregnancy

作　　者：张伟[1] 李刚 华成飞 王海波[2] 张同庆[3] 陈清亮 梁昊 刘宝辉[1] Zhang Wei;Li Gang;Hua Chengfei;Wang Haibo;Zhang Tongqing;Chen Qingliang;Liang Hao;Liu Baohui(Department of Interventional Radiology,First People′s Hospital of Zhengzhou,Zhengzhou 450004,China;Department of Interventional Radiology,Zhengzhou Central Hospital,Zhengzhou 450007,China;Department of Interventional Radiology,3rd People′s Hospital of Zhengzhou,Zhengzhou 450000,China;Department of Radiology,Henan No.3 Provincial People′s Hospital,Zhengzhou 450006,China)

机构地区：[1]郑州市第一人民医院介入科,郑州450004 [2]郑州市中心医院外周介入科,郑州450007 [3]郑州市第三人民医院介入科,郑州450000 [4]河南省直第三人民医院放射科,郑州450006

出　　处：《中华医学杂志》2022年第2期130-135,共6页National Medical Journal of China

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210712)。

摘　　要：目的分析早期剖宫产切口部妊娠(CSP)患者侧支供血的发生情况及影响因素。方法本研究为多中心的病例对照研究,以郑州市第一人民医院、郑州市中心医院、郑州市第三人民医院、河南省直第三人民医院2017年1月1日至2020年6月30日219例CSP住院患者为研究对象,获取其临床资料,数字减影血管造影影像分析采用双盲法,将研究对象分为有侧支供血组和无侧支供血组,计算早期CSP侧支供血的发生率,采用多因素logistic回归模型分析早期CSP侧支供血发生的影响因素,同时比较两组患者子宫动脉栓塞术(UAE)后的临床结局情况。结果219例早期CSP患者年龄为(32.4±5.0)岁,孕期为(51.0±10.6)d,早期CSP侧支供血发生率为12.3%(27例),发生于左侧者16例,右侧者6例,双侧者5例;共发现43条侧支供血血管,平均每患者1.59条,侧支供血血管来源以膀胱动脉最多见,占74.4%(32/43),其次为阴部内动脉,占18.6%(8/43)。多因素分析结果显示,孕周≥8周、妊娠囊最大径≥50 mm、妊娠囊呈富血供型是早期CSP侧支供血发生的影响因素,OR值(95%CI)分别为3.68(1.06~12.76)、7.00(1.52~32.19)、9.96(3.59~27.58),均P<0.05。两组CSP患者UAE成功率为100%,在UAE后24 h血清β-人绒毛膜促性腺激素(β-HCG)下降程度、清宫术中阴道大出血、子宫切除、月经恢复时间差异均无统计学意义(均P>0.05)。结论早期CSP具有一定的侧支供血发生率,有可能对UAE的疗效及患者安全产生不利影响;孕周、妊娠囊最大径及其血管化程度在提示早期CSP侧支供血上具有一定的价值,有助于UAE过程中对妊娠囊的完全栓塞。Objective To investigate the characteristics and effect factors of collateral blood supply of patients with early trimester cesarean scar pregnancy(CSP).Methods This study was a multicenter case-control study,with 219 inpatients with CSP in First People′s Hospital of Zhengzhou,Zhengzhou Central Hospital,Third People′s Hospital of Zhengzhou and Henan No3 Provincial People′s Hospital from January 1,2017 to June 30,2020 who were selected to obtain their clinical data.Double-blind method was performed in digital subtraction angiography imaging analysis.The patients were divided into collateral blood supply group and non-collateral blood supply group,and the incidence of collateral blood supply of patients with early trimester CSP was calculated.Multivariate binary logistic regression analysis was performed to find the independent risk factors of collateral blood supply of patients with early trimester CSP.As well,clinical outcomes after uterine artery embolization(UAE)were compared between the two groups.Results A total of 219 patients with early trimester CSP have average age of(32.4±5.0)years old and average pregnancy of(51.0±10.6)days.The incidence of collateral blood supply was 12.3%(27 cases),of which16 cases were on the left,6 on the right and 5 in both sides.A total of 43 collateral vessels were found,with 1.59 vessels per patient on average.Bladder artery was the most common source of collateral blood supply,accounting for 74.4%(32/43),followed by internal pudendal artery for 18.6%(8/43).Multivariate binary logistic regression analysis showed that gestational weeks≥8 weeks,maximum diameter of gestational sac≥50 mm and rich blood supply of gestational sac are independent risk factors for collateral blood supply of patients with early trimester CSP,with OR(95%CI)3.68(1.06-12.76),7.00(1.52-32.19)、9.96(3.59-27.58),respectively,all P<0.05.The success rates of UAE were 100%in both groups.The reduction in serumβ-Human chorionic gonadotropin(β-HCG)level at 24 hours after UAE,vaginal bleeding during ut

关 键 词：妊娠 异位 血管造影术 数字减影 剖宫产切口部妊娠 血液供应 

分 类 号：R714.22[医药卫生—妇产科学]