超声量化评分评估子宫动脉栓塞术后清宫治疗瘢痕妊娠预后的临床价值  

Clinical value of ultrasound quantitative score in evaluating the prognosis of cesarean scar pregnancy treated by curettage after uterine artery embolization

作　　者：胡孝辉 桂霜 李蒙森 HU Xiaohui;GUI Shuang;LI Mengsen(Department of Gynecology,the First Maternity and Infant Hospital,Tongji University,Shanghai 201204,China)

机构地区：[1]同济大学附属第一妇婴保健院妇科,上海市201204 [2]上海交通大学医学院附属第九人民医院超声医学科

出　　处：《临床超声医学杂志》2023年第7期551-555,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨超声量化评分评估子宫动脉栓塞术(UAE)后清宫治疗瘢痕妊娠(CSP)预后的临床价值。方法收集于我院首次行UAE+超声引导下清宫术治疗的CSP患者55例,术前均行超声检查分析其典型超声特征(包括CSP分型、孕囊或包块最大径、有无胎心、瘢痕处剩余肌层厚度、血流分级);绘制受试者工作特征(ROC)曲线分析各超声特征评估CSP严重程度的效能。对5个超声特征分别进行超声量化评分,根据评分结果分为低风险组(总分0~2分)、中风险组(总分3~5分)和高风险组(总分6~8分),比较各组UAE+超声引导下清宫术治疗后是否需行二次补救手术、术中出血量、术后是否形成包块或血肿及其消失时间、术后并发症情况等。结果ROC曲线分析显示,瘢痕处剩余肌层厚度、CSP分型、孕囊或包块最大径、血流分级、有无胎心评估CSP严重程度的曲线下面积(AUC)分别为0.812、0.804、0.778、0.740、0.711(均P<0.05)。根据超声量化评分结果,将55例患者分为低风险组10例,中风险组33例,高风险组12例。除低风险组全部一次治疗成功外,中风险组3例(9.09%)另行宫腔镜治疗,高风险组5例(41.67%)另行宫腔镜、腹腔镜下或开腹子宫下段病灶切除术,所有患者均保留子宫。与低、中风险组比较,高风险组二次手术率高、术中出血量多、术后包块或血肿形成率高、术后并发症发生率高、术后包块或血肿消失时间长、血清人绒毛膜促性腺激素转阴时间长,差异均有统计学意义(均P<0.05)。结论超声量化评分可以评估CSP的严重程度,并能有效预测UAE+超声引导下清宫术治疗CSP患者的疗效及相关并发症,有一定的临床价值。Objective To explore the clinical value of ultrasound quantitative score in evaluating the prognosis of cesarean scar pregnancy treated by curettage after uterine artery embolization(UAE).Methods A total of 55 cases of cesarean scar pregnancy(CSP)patients who underwent UAE+ultrasound-guided curettage in our hospital for the first time were collected.Preoperative ultrasonography was performed to analyze their typical ultrasonic features(including CSP classification,maximum diameter of pregnancy sac or mass,presence or non-presence of fetal heart,thickness of remaining scar muscle layer,and blood flow classification).Receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of each ultrasonic feature in evaluating CSP severity.According to the total score of ultrasound quantitative score,the low-risk group(0~2 points),the medium-risk group(3~5 points)and the high-risk group(6~8 points)were divided.After UAE+ultrasound-guided curettage treatment,the need for a second remedial operation,the amount of intraoperative bleeding,the formation of postoperative mass and the time of mass disappearance,and the postoperative complications of each group were compared.Results ROC curve analysis showed that the area under the curve(AUC)of thickness of remaining scar muscle layer,CSP classification,maximum diameter of pregnancy sac or mass,blood flow classification for evaluating the severity of CSP were 0.812,0.804,0.778,0.740,and 0.711,respectively(all P<0.05).According to the results of ultrasound quantification score,55 patients were divided into low-risk group(10 cases),medium-risk group(33 cases)and high-risk group(12 cases).All patients underwent UAE+ultrasound-guided curettage for the first time except for the low-risk group,3 cases(9.09%)in the medium-risk group received additional hysteroscopic treatment,5 cases(41.67%)in the high-risk group received additional hysteroscopic,laparoscopic or open hysterectomy for the lower segment of the uterus,and all cases retained the uterus.Compared with the low-an

关 键 词：超声检查 量化评分 瘢痕妊娠 子宫动脉栓塞术 清宫术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.2[医药卫生—诊断学]