子宫瘢痕妊娠患者子宫动脉化疗栓塞+清宫术出血量相关因素分析

Relative factors analysis and case -control study on blood loss of uterine artery chemotherapy embolization +uterine cavity curettage in patients with uterine scar pregnancy

目的分析子宫瘢痕妊娠患者子宫动脉化疗栓塞+清宫术出血量的影响因素。方法采用1:1病例对照研究的方法回顾性分析达州市中心医院2010年10月～2012年10月的收治子宫瘢痕妊娠患者110例,其中2011年10月～2012年10月收治的子宫瘢痕妊娠患者55例为病例组,2010年10月～2011年9月收治的子宫瘢痕妊娠患者55例为对照组。病例组55例采用子宫动脉化疗栓塞+清宫术治疗,对照组55例采用常规清宫术治疗。比较两组年龄、孕龄、既往孕产次数、既往流产情况、术中出血量、血β-绒毛膜促性腺激素(β-HCG)降至正常的时间、住院时间等指标;采用Pearson相关或Spearman秩相关对后继清宫术出血量进行单因素相关分析,采用逐步法多元回归分析对后继清宫术出血量进行多因素相关分析。结果①病例组术中出血量[(64.7±24.0)mL]、血β-HCG降至正常的时间[(15.8±4.1)d]、住院时间[(5.1±1.5)d]等均优于对照组[(153.4±60.1)mL、(24.3±6.2)d、(9.2±3.7)d],差异均有统计学意义(均P<0.05)。②单因素分析结果提示,孕龄(r=0.074)、既往孕产次数(r=0.024)、既往流产情况[有(r=0.112)、无(r=-0.054)]、后继清宫术与子宫动脉化疗栓塞间隔时间(r=0.217)、血β-HCG降至正常的时间(r=0.219)、子宫动脉化疗栓塞(r=0.741)与后继清宫术出血量具有相关性,差异均有统计学意义(均P<0.05);年龄与后继清宫术出血量无相关性(P>0.05)。③多元回归分析结果显示,孕龄(β=0.073)、既往孕产次数(β=0.495)、既往流产情况(有、无)(β=0.0.428)、后继清宫术与子宫动脉化疗栓塞间隔时间(β=0.335)、血β-HCG降至正常的时间(β=0.185)、子宫动脉化疗栓塞(β=0.781)与后继清宫术出血量相关,差异均有统计学意义(均P<0.05);年龄与后继清宫术出血量无相关性(P>0.05)。结论子宫瘢痕妊娠患者子宫动脉化疗栓塞+清宫术出血量与多种因素相关,子宫动脉化疗栓塞可有效降低后继清宫术的出血量,值得临床应用。

Objective To analyze the relative factors analysis and case-control study on blood loss of uterine artery chemotherapy embolization＋uterine cavity curettage in patients with uterine scar pregnancy. Methods 110 patients with uterine scar pregnancy in Center Hospital of Dazhou City from October 2010 to October 2012 were retrospectively analyzed using the 1：1 case-control study, 55 cases from October 2011 to October 2012 were selected as case group,55 cases from October 2010 to September 2011 were selected as control group. 55 cases in case group were treated with uterine artery chemotherapy embolization＋uterine cavity curettage, 55 cases in control group were treated with conventional complete curettage of uterine cavity. The indexes of age, gestational age, number of pregnancy, abortion situation, intraoperatve blood loss, the time of blood β-HCG decreased to normal, hospital stays were compared; Pearson correlation and Spearman rank correlation were used to take the single factor correlation analysis of intraoperative blood loss in subsequent uterine cavity curettage, step by step method of multiple regression analysis was used to take the multiple factor correlation analysis of intraoperative blood loss in subsequent uterine cavity curettage. Results①Intraoperatve blood loss, the time of blood β-HCG decreased to normal and hospital stays in case group [（64.7±24.0） mL,（15.8±4.1）d, （5.1±1.5） d] were all better than those in control group, the differences were statistically significant （P 〈 0.05）. ②Gestational age （r = 0.074）, number of pregnaney （r = 0.024）, abortion situation [yes （r=0.112）, no （r = -0.054）], time interval of subsequent uterine cavity curettage and uterine artery chemotherapy embolism （r = 0.217）, the time of blood β-HCG decreased to normal （r = 0.219）, uterine artery chemotherapy embolism （r = 0.741） were found to have correlation with intraoperative blood loss in subsequent uterine cavity curettage, the differences were statistically significant （P 〈 0.05） according to the results of single factor analysis; no correlationship was found between the age and intraoperative blood loss in subsequent uterine cavity curettage （P 〉 0.05）.③Gestational age （β = 0.073）,number of pregnancy （β = 0.495）, abortion situation （β = 0. 0.428）, time interval of subsequent uterine cavity curettage and uterine artery chemotherapy embolism （β = 0.335）, the time of blood β-HCG decreased to normal （β = 0.185）, uterine artery chemotherapy embolism （β = 0.781） were found to have correlation with intraoperative blood loss in subsequent uterine cavity curettage, the differences were statistically significant （P 〈 0.05） according to the results of multiple regression analysis; no correlationship was found between the age and intraoperative blood loss in subsequent uterine cavity curettage （P 〉 0.05）. Conclusion The bleeding quantity of uterine artery chemotherapy embolization＋uterine cavity curettage has correlationship with multi-factors, uterine artery chemotherapy embolization can ;effectively reduce the blood loss in subsequent uterine cavity curettage, it is worthy of clinical application.