超声引导下剖宫产瘢痕妊娠清宫术的安全可行性及其影响因素

Safety and feasibility of ultrasound-guided hysterectomy for cesarean section scar pregnancy and its influencing factors

目的探讨超声引导下剖宫产瘢痕妊娠(CSP)清宫术的安全可行性及其影响因素。方法选取该院2016年6月至2019年2月收治的行超声引导下清宫术的57例CSP患者,根据手术结果分为研究组(47例)与对照组(10例),对照组为清宫术中由于各种原因而导致更换术式或出血较多者。比较各组的人口学资料、化验室指标和超声指标,采用多因素Logistic回归分析筛选出患者发生手术失败的危险因素。结果研究组的人绒毛膜促性腺激素(hCG)、胎囊大小(GS)以及停经天数显著低于对照组,剖宫产次、剖宫产瘢痕的肌层厚度(CSM)显著高于对照组,差异均具有统计学意义(P<0.05);多因素Logistic回归分析结果表明,患者清宫手术失败的独立影响因素是hCG、胎囊直径、瘢痕肌层厚度(P<0.05)。结论早期CSP患者建议行直接清宫术,特别是停经时间短、血清hCG水平不高、胎囊较小、瘢痕肌层较厚的患者,通过清宫治疗可以达到安全而有效的治疗目的。

【Objective】To study the safety and feasibility of ultrasound-guided cesarean section scar pregnancy(CSP) and its influencing factors.【Methods】The subjects of this study were 57 CSP patients who underwent ultrasound-guided hysterectomy in our hospital from June 2016 to February 2019. According to the surgical results, the patients were divided into the research group(n=47) and the control group(n=10). The control group was the patients who changed surgical method or had more bleeding during uterine curettage due to various reasons. Demographic data, laboratory indexes and ultrasonic indexes of each group were compared, and multivariate Logistic regression analysis was used to screen out the risk factors of surgical failure.【Results】HCG, fetal sac diameter and the duration of menopause in the research group were significantly lower than those in the control group, and cesarean section times, scar muscle thickness were significantly higher than those in the control group, with statistically significant differences(P<0.05). The results of multivariate logistic regression analysis showed that hCG, fetal sac diameter, and thickness of scar muscle layer were the independent factors influencing the failure of uterine clearance surgery(P<0.05), while the independent factors influencing postoperative lesion residue were menopause time, hCG, and fetal sac diameter(P<0.05).【Conclusion】Early CSP patients are advised to undergo direct hysterectomy, especially those with short period of menopause, low serum hCG level, small fetal sac, and thick scar muscle layer.