瘢痕妊娠宫腔镜术中大出血与影像参数相关研究  

Study on the Correlation between Massive Hemorrhage and Imaging Parameters in Hysteroscopic Surgery for Scar Pregnancy

作　　者：王全帮 季鹏[1] 杨艳[1] WANG Quan-bang;JI Peng;YANG Yan(Imaging Center,Anhui Medical University Hefei Third Clinical College,the Third People's Hospital of Hefei,Hefei 230022,Anhui Province,China)

机构地区：[1]安徽医科大学合肥第三临床学院,合肥市第三人民医院影像中心,安徽合肥230022

出　　处：《中国CT和MRI杂志》2024年第6期148-150,共3页Chinese Journal of CT and MRI

基　　金：合肥市名医工作室建设项目(合卫人{2019}167号)。

摘　　要：目的 探讨磁共振影像参数与瘢痕妊娠宫腔镜术中出血量相关性。方法 搜集合肥市三院2018年07月至2021年10月宫腔镜切除瘢痕妊娠患者39例,按出血量是否大于中位数50mL,把病倒分成两组,进行病例对照研究。利用t或秩和检验比较两组临床及影像参数差异性,取较小P值纳入回归模型,赋值阳性事件大出血为1,非大出血为0,计算从对照组到病例组参数每增加一个单位,其影响大出血的相对危险度。结果 对比24例非大出血和15例大出血病例参数,组间孕囊变形度、瘢痕深度和宽度数据存在差异,P值小于0.05;多因素Iogistic回归显示瘢痕宽度是大出血的独立影响因素(相对危险度OR值=1.246,95%CI 1.038-1.495,P=0.018)。其预测大出血的ROC曲线AUC=0.831,P=0.001,当瘢痕宽度大于16.5 mm时,预测敏感度为0.67,特异度为0.79。结论 瘢痕妊娠宫腔镜术中大出血与孕囊变形度(圆度)、瘢痕深度和宽度相关,且瘢痕宽度是瘢痕妊娠更重要的危险度评价指标。Objective To investigate the correlation between magnetic resonance imaging parameters and intraoperative blood loss in scar pregnancy hysteroscopy.Methods A total of 39 patients with scar pregnancy who underwent hysteroscopic resection from July 2018 to October 2021 in Hefei Third Hospital were collected.According to whether the amount of bleeding was greater than the median50 ml,the cases were divided into two groups for case-control study.The t or rank sum test was used to compare the differences of clinical and imaging parameters between the two groups.The smaller P value was included in the regression model,and the positive event was assigned to 1 for massive hemorrhage and 0 for non-massive hemorrhage.The relative risk of massive hemorrhage was calculated for each additional unit from the control group to the case group.Results Comparing the parameters of 24 cases of non-hemorrhage and 15 cases of hemorrhage,there were differences in gestational sac deformation,scar depth and width between the groups,and the P value was less than0.05.Multivariate logistic regression showed that scar width was an independent influencing factor for massive hemorrhage(relative risk OR=1.246,95 % CI 1.038-1.495,P=0.018).The ROC curve AUC=0.831,P=0.001.When the scar width was greater than 16.5mm,the predictive sensitivity was 0.67and the specificity was 0.79.Conclusion Massive hemorrhage during hysteroscopic surgery for scar pregnancy is related to the deformation(roundness) of gestational sac,scar depth and width,and sca r width is a more importa nt risk evaluation index for scar pregnancy.

关 键 词：瘢痕妊娠 宫腔镜 大出血 危险度 磁共振影像参数 

分 类 号：R619.6[医药卫生—外科学]