根据超声分型及定量评分选择剖宫产切口部妊娠手术方式  

Ultrasonic classification and quantitative scoring in planning surgical treatment of cesarean scar pregnancy

作　　者：于梦霞 李晓琴 杨敏 付吉鹤 王玲燕 YU Mengxia;LI Xiaoqin;YANG Min;FU Jihe;WANG Lingyan(Department of Ultrasound,the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University,Changzhou 213164,China)

机构地区：[1]南京医科大学附属常州第二人民医院超声科,江苏常州213164

出　　处：《中国医学影像技术》2022年第12期1848-1852,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的观察超声分型及超声定量评分对于选择手术治疗剖宫产切口部妊娠(CSP)方式的价值。方法回顾性分析111例CSP患者,根据手术方式分为宫腔镜组(n=69)和腹腔镜组(n=42),基于术前超声表现对CSP进行分型(Ⅰ~Ⅳ型)及评分(0~10分);比较组间术前超声指标、围手术期及术后恢复情况,分析影响选择CSP手术方式的相关因素。结果宫腔镜组孕囊最大径小于腹腔镜组(P<0.05),以39.00 mm为截断值,以之选择手术方式的曲线下面积(AUC)为0.640。宫腔镜组剩余肌层厚度大于腹腔镜组(P<0.05)。宫腔镜组包括51例Ⅰ型、12例Ⅱ型、4例Ⅲ型及2例Ⅳ型CSP,腹腔镜组包括7例Ⅰ型、24例Ⅱ型、5例Ⅲ型及6例Ⅳ型CSP,组间CSP分型差异具有统计学意义(P<0.05)。宫腔镜组超声定量评分低于腹腔镜组(P<0.05),取3.68分为截断值,以之选择手术方式的AUC为0.638。logistic回归分析显示,超声分型是CSP手术方式的独立影响因素,分型越高越倾向于腹腔镜手术(OR=13.205,P<0.05)。宫腔镜组术中出血量显著少于腹腔镜组(P<0.05)。术后均未出现严重并发症,患者均恢复良好。结论超声分型对选择手术治疗CSP方式具有重要意义。Objective To observe the value of ultrasonic classification and quantitative scoring in planning surgical treatment of cesarean scar pregnancy(CSP).Methods Data of 111 CSP patients were retrospectively analyzed.The patients were divided into hysteroscopic group(n=69)and laparoscopic group(n=42)according to surgical methods.CSP was classified(typeⅠ—Ⅳ)and scored(0—10 points)based on the preoperative ultrasound manifestations.The preoperative ultrasonic parameters,as well as status of perioperative period and postoperative recovery were compared between groups,and the related impact factors on the choice of surgical methods for treating CSP were screened.Results The maximum diameter of the pregnancy sac in hysteroscopic group was smaller than that in laparoscopic group(P<0.05).Taken 39.00 mm as the cut-off value,the area under the curve(AUC)was 0.640.The thickness of the remaining muscularis in hysteroscopic group was larger than that in laparoscopic group(P<0.05).There were 51 cases of typeⅠ,12 cases of typeⅡ,4 cases of typeⅢand 2 cases of typeⅣCSP in hysteroscopic group,while 7 cases of typeⅠ,24 cases of typeⅡ,5 cases of typeⅢand 6 cases of typeⅣCSP in laparoscopic group,the difference was significant(P<0.05).The quantitative ultrasonic score of hysteroscopic group was lower than that of laparoscopic group(P<0.05).Taken 3.68 points as the cut-off value,the AUC was 0.638.Logistic regression analysis showed that ultrasonic classification was an impact factor of the choice surgical method for treating CSP,and the higher the classification,the more likely the laparoscopic surgery was choosn(OR=13.205,P<0.05).The intraoperative blood loss in hysteroscopic group was significantly smaller than that in laparoscopic group(P<0.05).No serious complications occurred,and all patients recovered well after surgical treatments.Conclusion Ultrasound classification was of great significance in planning surgical treatment of cesarean scar pregnancy.

关 键 词：妊娠 异位 腹腔镜 宫腔镜 超声检查 

分 类 号：R714.2[医药卫生—妇产科学] R445.1[医药卫生—临床医学]