剖宫产瘢痕部位妊娠术后不孕及再次妊娠结局的差异性分析  

Differential Analysis of Infertility and Subsequent Pregnancy Outcome after Cesarean Section Scar Pregnancy

作　　者：乐芳舒 冯同富[1] 陶晓玲[1] 雷晓静 张媛 杜欣[1] LE Fangshu;FENG Tongfu;TAO Xiaoling(Department of Gynecology,Hubei Maternal and Child Health Hospital,Wuhan Hubei 430064,China)

机构地区：[1]湖北省妇幼保健院妇科,湖北武汉430064

出　　处：《实用妇产科杂志》2023年第5期395-398,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:分析导致剖宫产瘢痕部位妊娠(CSP)术后不孕或再次妊娠的发生率和妊娠结局的影响因素。方法:回顾性分析在湖北省妇幼保健院2017年5月至2021年5月确诊并治疗CSP患者的再次妊娠情况,将患者分成复发性切口妊娠(RCSP)组((印)n(正)=16)、宫内妊娠组((印)n(正)=77)和继发不孕组((印)n(正)=12)3组,根据3组患者首次CSP的临床资料及术后月经恢复情况分析导致患者继发性不孕或RCSP的原因。结果:RCSP、宫内妊娠和继发不孕3组患者在首次CSP的一般临床资料中,继发性不孕组患者的年龄最大及距前次剖宫产的时间最长,与其他两组相比差异有统计学意义((印)P(正)<0.05);3组患者的孕次、产次、既往剖宫产次数、流产次数及诊断CSP的孕周差异无统计学意义(P>0.05);3组患者孕囊大小、肌层厚度、CSP分型、术前血β-hCG及手术方式差异无统计学意义(P>0.05);3组患者首次CSP术后月经恢复时间差异无统计学意义(P>0.05),但是继发性不孕组患者的月经量减少率最高,与其他两组相比差异有统计学意义((印)P(正)<0.05)。切除瘢痕组织对患者再次妊娠类型无明显影响,结果差异无统计学意义(P>0.05)。结论:CSP术后患者继发不孕的原因与患者年龄大、距前次剖宫产时间长及术后月经量减少可能有关。导致RCSP的因素不明,通过手术修复瘢痕缺陷并不能减少RCSP的发生。Objective:To analyze the factors leading to infertilityand recurrent cesarean scar pregnancy(RC-SP)after cesarean scar pregnancy(CSP).Methods:Retrospective analysis of CSP patients diagnosed and trea-ted in Hubei Maternal and Child Health Hospital from 2017 to May 2021.According to the subsequent pregnan-cies,patients were divided into three groups:RCSP(n=16),intrauterine pregnancy(n=77)and infertility(n=12).The causes of infertility or RCSP were analyzed according to the clinical data of CSP and postoperative men-strual recovery in the three groups.Results:ln the general clinical data of RCSP,intrauterine pregnancy and infer-tility groups,the infertility group had the oldest age and the longest time to the previous cesarean section(P<0.05);There was no difference in the number of pregnancy,delivery,cesarean section and abortion among the three groups(P>0.05).There was no difference in the time of cSP diagnosis among the three groups(P>0.05).There were no differences in the size of pregnancy sac,thickness of muscle layer,CSP classification,pre-operative hCG results and surgical methods among the three groups(P>0.05).There was no difference in the time of menstrual recovery after the CsP between the three groups(P>0.05),but the rate of menstrual volume reduction was the highest in the infertility group(P<0.05).Removal of scar tissue had no significant effect on subsequent pregnancy types of patients(P>0.05).Conclusions:The causes of infertility in CsP patients are re-lated to older age,longer time to cesarean section and reduced postoperative menstrual volume.

关 键 词：剖宫产瘢痕部位妊娠 复发性切口妊娠 不孕 宫内妊娠 

分 类 号：R714.1[医药卫生—妇产科学]