疤痕妊娠明胶海绵介入栓塞后子宫动脉再通的影响因素  

Factors influencing uterine artery recanalization after gelatin sponge interventional embolization of cesarean scar pregnancy

作　　者：徐少锋 王致强 胡红杰[1] Shaofeng Xu;Zhiqiang Wang;Hongjie Hu(Department of Radiology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Zhejiang Hangzhou 310016;Department of Radiology,Ningbo Women and Children's Hospital,Zhejiang Ningbo 315300,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院放射科,浙江杭州310016 [2]宁波市妇女儿童医院放射科,浙江宁波315300

出　　处：《中华介入放射学电子杂志》2023年第1期30-34,共5页Chinese Journal of Interventional Radiology：electronic edition

摘　　要：目的探讨疤痕处妊娠子宫动脉明胶海绵栓塞后血管再通的影响因素,以期完善手术操作方式,提高血管再通率。方法回顾性分析2010年1月—2019年12月于宁波市妇女儿童医院两次行介入治疗的患者41例。收集病例基础资料和手术资料,评估血管管径、栓塞部位及血管再通情况。据子宫动脉的再通情况,将所有血管(82条)分为血管再通组(48条)和血管闭塞组(34条)。对子宫动脉血管内径行t检验,两次手术间隔时间行U检验,栓塞部位及左右侧别行卡方检验,并对各因素行Logistics回归分析,以P<0.05为有统计学意义。结果两次介入治疗病例资料比较显示年龄、孕次、手术时间及术后清宫大出血差异有统计学意义(P<0.05)。使用明胶海绵子宫动脉栓塞术后血管再通率为58.5%(48/82)。栓塞至子宫动脉不同部位,再通率分别为下降段36.4%、横段44.0%、上行支71.7%,差异有统计学意义(χ^(2)=7.78,P=0.023)。经单因素Logistics回归分析,子宫动脉栓塞部位从子宫动脉由近端至远端可增加血管再通率(OR=2.359,95%CI:1.226~4.54,P=0.013),其霍斯默-莱梅肖检验为(χ^(2)=0.693,P=0.424),预测百分比为65.9%。结论子宫动脉栓塞部位是用明胶海绵介入治疗疤痕处妊娠后血管再通的关键因素,且栓塞至子宫动脉上行支区段时血管再通率最高,可为同类手术的栓塞满意程度提供借鉴意义。Objective To investigate the factors influencing revascularization after gelatin sponge embolization of cesarean scar pregnancy,in order to improve the surgical procedure and increase the revascularization rate.Methods Retrospective analysis of 41 patients who underwent interventional treatment twice at Ningbo Women and Children's Hospital from January 2010 to December 2019.Case-based and surgical data were collected to assess vessel diameters,embolic sites and vessel recanalisation.All vessels(82)were divided into a revascularisation group(48)and an occlusion group(34)according to the recanalisation of the uterine arteries.A t-test was performed for the internal diameter of the uterine artery,a U-test for the interval between two procedures,a chi-square test for the site of embolism and the left and right sides,and a logistic regression analysis for each factor,with P<0.05 being considered statistically significant.Results Comparison of the case-based data between the two interventions showed statistically significant differences(P<0.05)in age,gestation,time of surgery and post-operative clearance for haemorrhage.The revascularization rate after uterine artery embolization with gelatin sponge was 58.5%(48/82).The recanalisation rate was 36.4%in the descending segment,44.0%in the transverse segment and 71.7%in the superior branch when embolized to different parts of the uterine artery,with statistically significant differences(χ^(2)=7.78,P=0.023).By univariate logistic regression analysis,uterine artery embolization site from proximal to distal uterine artery increased the revascularization rate(OR=2.359,95%CI:1.226~4.54,P=0.013)with a Hosmer-Lemeshaw test of(χ^(2)=0.693,P=0.424)and a prediction percentage of 65.9%.Conclusions The site of uterine artery embolization is a key factor for revascularization after applying gelatin sponge intervention for cesarean scar pregnancy,and the highest rate of revascularization was observed when embolized to the segment of the superior branch of the uterine artery,which may

关 键 词：子宫动脉栓塞术 疤痕妊娠 血管再通 栓塞部位 子宫动脉上行支 

分 类 号：R714[医药卫生—妇产科学]