剖宫产瘢痕部位妊娠预后风险量化预评分系统的建立  

Preliminary establishment of quantitative pre-scoring system for prognostic risk for cesarean scar pregnancy

作　　者：张筱 闫璐[1] 李连心 于淼 张敬坤[1] 杜彦芳[1] ZHANG Xiao;YAN Lu;LI Lian-xin;YU Miao;ZHANG Jing-kun;DU Yan-fang(Department of Gynecology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院妇科,河北石家庄050000

出　　处：《河北医科大学学报》2022年第12期1439-1444,1448,共7页Journal of Hebei Medical University

基　　金：河北省医学科学研究重点课题计划(20160094)。

摘　　要：目的回顾性研究分析剖宫产瘢痕部位妊娠(cesarean scar pregnancy,CSP)不同治疗方法的治疗结局,探索影响CSP治疗结局的关键因素,建立临床量化预评分系统。方法回顾性分析在河北医科大学第二医院初次诊治的CSP患者240例。依据最终患者的治疗方式分为3组,即超声监测下清宫组、宫腔填塞组和腹腔镜(或开腹)手术组,比较3组临床、辅助检查资料及治疗成功率,找出影响治疗结局的因素,利用统计学中最佳尺度回归方法及数学模型计算出每个影响因素的权重并对其赋值,建立CSP风险量化预评分表,并进行初步的验证。结果CSP患者临床及超声特征中的妊娠囊最大径线,超声分型,剩余肌层厚度,血流分级,胎心搏动及术前血β-绒毛促性腺激素(human chorionic gonadotropin,β-HCG)水平6个变量在组间比较差异有统计学意义(P<0.05)。各影响因素对治疗结局的预测价值所占的权重分别为剩余肌层厚度(50.3%),超声分型(15.0%),妊娠囊血供血流分级(12.4%),妊娠囊最大径线(11.1%),胎心搏动有无(7.1%),术前血β-HCG水平(4.1%)。据此建立量化评分系统,并转换为10分制。对实际治疗方式与预测治疗方式进行一致性检验显示两者基本一致,Kappa系数为0.637。结论影响CSP治疗结局的因素有剩余肌层厚度,超声分型,妊娠囊血供血流分级,妊娠囊最大径线,胎心搏动有无及术前血清β-HCG值。根据上述影响因素在整体风险中的权重制定的量化评分系统可以预测CSP严重程度及需要选择的手术方案。Objective To retrospectively analyze the outcome of different treatment methods for cesarean scar pregnancy(CSP),to explore the key factors affecting the outcome of CSP treatment,and to establish a quantitative pre-scoring system in clinical practice.Methods In total,240 patients with CSP who were treated for the first time in the Second Hospital of Hebei Medical University were retrospectively analyzed.Patients were divided into three groups according to their treatment methods,namely,ultrasound-guided uterine clearance group,uterine packing group and laparoscopic surgery(or laparotomy)group.Clinical and auxiliary examination data and treatment success rate of patients in each group were compared to find out the factors affecting the treatment outcome.The optimal scale regression method and mathematical model in statistics were used to calculate the weight of each influencing factor and assign its value.The quantitative pre-evaluation score table of CSP risk was established to carry out preliminary verification.Results The differences in six variables,including the maximum diameter of the gestational sac,ultrasonic classification,thickness of the remaining muscle layer,blood flow classification,fetal heart beat andβ-human chorionic gonadotropin(β-HCG level)in the clinical and ultrasonic characteristics of the patient were statistically significant(P<0.05).The weights of the predictive value of each influencing factor in the treatment outcome were residual muscle layer thickness(50.3%),ultrasonic classification(15.0%),blood flow grade of pregnancy sac(12.4%),the maximum diameter of pregnancy sac(11.1%),presence or absence of fetal heart beat(7.1%),and preoperative bloodβ-HCG level(4.1%).A quantitative scoring system was established accordingly and converted into a 10 point system.The consistency test showed that the actual treatment mode was basically consistent with the predicted treatment mode,and the Kappa coefficient was 0.637.Conclusion The influencing factors for the outcome of CSP treatment were residua

关 键 词：妊娠 剖宫产术 评分系统 危险因素 

分 类 号：R339.2[医药卫生—人体生理学]