剖宫产术后子宫瘢痕妊娠患者大出血的危险因素分析

Analysis for risk factors of cesarean scar pregnancy patients with bleeding

目的探讨剖宫产术后子宫瘢痕妊娠（CSP）大出血的危险因素,为临床诊治提供理论依据。方法选择2007年5月-2015年10月唐山市中医医院收治的B超检查资料完整的97例CSP患者的临床资料,根据治疗中出血情况将患者分为大出血组（38例）和非大出血组（59例）。分析两组患者治疗前病灶直径、类型、血流分级及残余肌层厚度。采用Logistic回归法分析剖宫产瘢痕妊娠大出血的危险因素。结果大出血组患者病灶直径明显大于非大出血组[（50.0±16.0）、（24.2±15.8）cm,P〈0.01],瘢痕处残余肌层厚度明显小于非大出血组[（1.0±0.7）、（3.1±1.9）cm,P〈0.01]。两组病灶类型及血流分级比较差异均有统计学意义（均P〈0.01）。多因素Logistic回归分析显示,病灶的直径、类型、血流分级及瘢痕处残余肌层厚度与大出血相关（P〈0.05或P〈0.01）。结论病灶直径、分型、血流分级及瘢痕处残余肌层厚度为CSP大出血的危险因素,超声检查能正确评估CSP患者的预后,并对指导临床治疗有重要意义。

Objective To discuss the risk factors of Massive Hemorrhage during cesarean scar pregnancy（CSP）, and provide theoretical basis for clinical diagnosis and treatment. Methods Clinical date of 97 CSP patients with complete B-ultrasound were chosen in Tangshan TCM Hospital from May 2007 to October 2015. These patients were divided into two groups： massive hemorrhage group（38 cases） and non-massive hemorrhage group（59 cases）. The lesion diameter, type, flow grade and residual muscle thickness of two groups before treatment were analyzed. The potential risk factors of massive hemorrhage were analyzed with Logistic regression analysis. Results The lesion diameter of the massive hemorrhage group was obvious bigger than the non-massive hemorrhage group [（50.0±16.0）,（24.2±15.8） cm, P〈0.01]. The scar residual muscle thickness was significantly thinner than the non-massive hemorrhage group [（1.0±0.7）,（3.1±1.9） cm, P〈0.01]. There was statistically significant in lesion type and degree of blood flow（all P〈0.01）. The size and type of lesions, flow grade, and residual muscular thickness were related to massive haemorrhage by Logistic regression model（P〈0.05 or P〈0.01）. Conclusion The size and type of lesions, flow grade, and residual muscular thickness are the risk factors for CSP bleeding. Uhrasonography can accurately assess the prognosis of patients with CSP, and it has important significance to guide clinical treatment.