MRI测量Ⅱ及Ⅲ型剖宫产瘢痕妊娠病灶大小对微创治疗方式选择的意义

The significance on the selection of minimally invasive treatment with MRI measuring the size of Ⅱ and Ⅲ cesarean scar pregnancy

目的:探讨核磁共振(MRI)影像上Ⅱ及Ⅲ型剖宫产瘢痕妊娠(CSP)病灶的长度(L)及高度(H)与临床微创治疗方式选择的关系。方法:回顾分析中国医科大学附属盛京医院第一微创妇科2016年1月至2019年2月收治的110例Ⅱ及Ⅲ型CSP患者的临床资料。根据手术方式不同分为宫腔镜组(86例)及宫腹腔镜联合组(24例);根据术前是否行子宫动脉栓塞术(UAE)分为非UAE组(61例)及UAE组(49例)。通过测量MRI妊娠病灶的L和H,分别评估L、H、L*H、L/H及血人绒毛膜促性腺激素(HCG)对微创治疗方式选择及UAE治疗的影响,统计分析选择恰当治疗方式的临界指标。结果:宫腔镜组与宫腹腔镜联合组妊娠病灶的L、H、L*H及L/H比较,差异有统计学意义( P <0.05);L≥28.95mm、H≥26.59mm、L*H≥378.76分别是CSP病灶大小行宫腹腔镜联合治疗的临界值,L/H于临界值时有较好的特异度(95.3%),但敏感度低(33.3%)。非UAE组及UAE组妊娠病灶的L及血HCG比较,差异有统计学意义( P <0.05)。结论:测量MRI影像CSP病灶大小对于选择恰当微创治疗方式具有较好的指导价值。以妊娠病灶L≥28.95mm、H≥26.59mm或L*H≥378.76作为界定选择宫腹腔镜联合治疗的界定标准,可获得较好的特异度和敏感度。

Objective: To explore the relationship between the clinical minimally invasive surgery and the length(L) and height(H) of type Ⅱ and Ⅲ cesarean scar pregnancy(CSP) lesions on magnetic resonance examination(MRI). Methods: 110 patients diagnosed as type Ⅱ and Ⅲ CSP in Shenjing Hospital affiliated to China Medical University from Jan.2016 to Feb.2019 were included in the study.According to the different surgical methods,patients were divided into the hysteroscopic group and hysteroscopy-laparoscopic group as well as non-uterine artery embolization(UAE) group and UAE group.By measuring L and H of CSP on MRI,evaluating the effects of L,H,L*H,L/H and HCG on the selection of minimally invasive surgery and UAE therapy.Meanwhile analyzed the threshold of appropriate treatment. Results: The difference of L,H,L*H and L/H between the hysteroscopic group and the hysteroscopy-laparoscopic group was statistically significant ( P <0.05).When L≥28.95mm,H≥26.59mm,L*H≥378.76 were the threshold for selecting hysteroscopy-laparoscopic combined surgery.L/H has good specificity (95.3%) at the threshold,but the sensitivity was low(33.3%).The difference of L and HCG in non-UAE and UAE group was statistically significant( P <0.05). Conclusions: MRI measuring CSP lesion size has a good guiding value for selecting appropriate minimally invasive surgery.Choosing CSP lesions L≥28.95mm,H≥26.59mm or L*H≥378.76 as the threshold for hysteroscopy-laparoscopic treatment,both specificity and sensitivity can be obtained.