早期剖宫产瘢痕妊娠子宫动脉栓塞后清宫术中大出血发生及其影响因素  

Massivehaemorrhageduringcurettage after uterine arteryy embolization in early cesareansscar pregnancy and its influencing factors

作　　者：王海波[1] 李刚 陈清亮 梁昊 杨林[2] 张伟[2] WANG Haibo;LI Gang;CHEN Qingliang;LIANG Hao;YANG Lin;ZHANG Wei(Department of Radiology,Zhengzhou Municipal Seventh People's Hospital,Zhengzhou,Henan Province 450016,China)

机构地区：[1]郑州市第七人民医院放射科,河南郑州450016 [2]郑州市第一人民医院介入科 [3]河南省直第三人民医院放射科

出　　处：《介入放射学杂志》2023年第5期436-440,共5页Journal of Interventional Radiology

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210712)。

摘　　要：目的 探讨早期剖宫产瘢痕妊娠(CSP)患者子宫动脉栓塞术(UAE)后清宫术中大出血发生及其影响因素。方法 收集2015年1月1日至2021年12月31日3所医院出院的CSP患者临床资料,筛选出183例早期CSP患者。根据UAE后清宫术中是否发生子宫大出血,将患者分为大出血组(n=17)和非大出血组(n=166)。比较两组患者一般资料以及妊娠囊最大径、妊娠囊与膀胱后壁间子宫肌层厚度、妊娠囊血管化程度、妊娠囊侧支供血、妊娠囊供血血管未完全栓塞等指标。对组间比较差异有统计学意义的指标进行多因素logistic回归分析,绘制独立危险因素预测UAE后清宫术中大出血的受试者工作特征曲线(ROC),计算曲线下面积(AUC),比较AUC质量。结果 UAE后清宫术中大出血发生率为9.3%(17/183),未发生子宫切除及死亡等不良事件。两组年龄、孕期、末次剖宫产时间、妊娠囊最大径、妊娠囊血管化程度、妊娠囊侧支供血、妊娠囊供血血管未完全栓塞比较差异有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,妊娠囊最大径(OR=1.064,95%CI=1.021~1.108,P=0.003)、妊娠囊侧支供血(OR=6.026,95%CI=0.030~0.918,P=0.040)、妊娠囊供血血管未完全栓塞(OR=0.071, 95%CI=0.005~33.330,P=0.045))是UAE后清宫术中大出血的独立危险因素。妊娠囊最大径、妊娠囊侧支供血、妊娠囊供血血管未完全栓塞预测UAE后清宫术中大出血的AUC分别为0.686(95%CI=0.541~0.831,P<0.05)、0.811(95%CI=0.680~0.942,P<0.01))、0.609(95%CI=0.449~0.768,P>0.05)。妊娠囊最大径与妊娠囊侧支供血、妊娠囊最大径与妊娠囊供血血管未完全栓塞间AUC质量相近(P>0.05),妊娠囊侧支供血的AUC质量优于妊娠囊供血血管未完全栓塞(P=0.002)。结论 早期CSP患者UAE后清宫术中仍可能发生大出血,对患者安全造成不利影响。妊娠囊最大径、妊娠囊侧支供血和妊娠囊供血血管未完全栓塞均有一定的提示UAE后清宫�Objective To discuss the occurrence of massive haemorrhage during curettage after uterine artery embolization(UAE)in first trimester cesarean scar pregnancy(CSP),and to analyze its influencing factors.Methods The clinical data of CSP patients,who discharged from three hospitals,including Zhengzhou Municipal First People's Hospital,Henan Provincial No3 People's Hospital and Zhengzhou Municipal Seventh People's Hospital of China between January 1,2015 and December 31,2021 were collected,and a total of 183 first trimester CSP patients were screened out for this study.According to whether massive haemorrhage during curettage after UAE occurred or not,the patients were divided into massive haemorrhage group(n=17)and non-massive haemorhage group(n=166).The general data,maximum diameter of the gestational sac,myometrial thickness between the gestational sac and the posterior bladder wall,degree of vascularization of the gestational sac,collateral blood supply,and incomplete embolization of blood vessels supplied to the gestational sac,etc.were compare between the two groups.The indicators with statistically significant differences between the two groups were processed by multivariate logistic regression analysis so as to screen the independent risk factors for massive haemorrhage during curettage after UAE in first trimester CSP.The receiver operating characteristic(ROC)curve of the independent risk factors predicting massive haemorrhage during curettage after UAE were drawn,the areas under the curve(AUC)were calculated,and the qualities of AUC were compared.Results The incidence of massive haemorrhage during curettage after UAE in 183 first trimester CSP patients was 9.3%(17/183),and no adverse events such as hysterectomy or death occurred.There were statistically significant differences in the age,gestation,time of last cesarean section,maximum diameter of gestational sac,degree of vascularization of gestational sac,collateral blood supply of gestational sac and incomplete embolization of blood supply vessels of gesta

关 键 词：剖宫产瘢痕妊娠 子宫动脉 栓塞术 出血 危险因素 

分 类 号：R713.8[医药卫生—妇产科学]