孕囊型剖宫产瘢痕部位妊娠治疗失败的相关因素分析

Risk Factors associated with Failed Treatment in Gestational Sac Type Cesarean Scar Pregnancy

目的:探讨孕囊型剖宫产瘢痕部位妊娠(CSP)超声监视下清宫术失败及失败后宫腔填塞压迫止血再失败的相关因素。方法:总结2006年7月至2016年7月于河北医科大学第二医院行超声监视下清宫术治疗的291例孕囊型CSP患者的病历资料,采用Logistic回归分析超声监视下清宫术失败及失败后宫腔填塞压迫止血再失败的相关因素。结果:超声监视下清宫术失败率为15.8%(46/291),清宫失败后28.3%(13/46)患者通过宫腔填塞压迫止血失败。经Logistic回归分析表明,超声监视下清宫术失败的相关因素是超声分型(OR 7.773,95%CI 3.038~19.885)、头臀长(OR5.561,95%CI 2.974~10.400)、血流分级(OR 2.420,95%CI 1.400~4.183)和术前血β-HCG水平(OR 1.914,95%CI 1.113~3.293)。宫腔填塞压迫止血失败的相关因素是血流分级(OR 19.738,95%CI 2.596~150.058)。结论:超声分型中级别越高、头臀长越长、孕囊及其周围血流越丰富、术前血β-HCG水平越高,清宫失败的可能性越大。清宫术失败后,孕囊及其周围血流越丰富,宫腔填塞压迫止血失败的风险相对较高。

Objective：To investigate the risk factors of unsuccessful ultrasound-guided dilatation and curettage D＆C） and the followed uterine cavity tamponade oppression. Methods：Retrospective analysis was conducted in 291 gestationat sac type CSP patients received ultrasound-guided D＆C in second hospital of Hebei Medical University from July 2006 to July 2016. Results：The rate of unsuccessful ultrasound-guided D＆C was 15.8% （46/ 291 ）. The rate of unsuccessful uterine cavity tamponade oppression was 28.3% （ 13/46）. Logistic multivariate analysis showed：the risk factors associated with the unsuccessful ultrasound-guided D＆C group were ultrasound type（ OR 7. 773,95% CI 3. 038 -19. 885） ,crown-rump length（ OR 5. 561,95% CI 2.974 -10. 400 ）, the grade of blood flow （ OR 2. 420, 95% CI 1. 400 - 4. 183） and preoperative serum β-HCG level （ OR 1. 914, 95% CI 1.113 -3. 293 ）. The grade of blood flow （ OR 19. 738,95% CI 2. 596 -150. 058 ） was the risk factor associated with unsuccessful uterine cavity tamponade oppression. Conclusions：For the gestational sac type CSP patients with higher ultrasound type,longer crown-rump length,greater blood flow, higher preoperative blood HCG level, the ultrasound-guided D＆C was more easily failed. For the gestational sac type CSP patients with greater blood flow, hemorrhage was more difficultly controlled.