剖宫产瘢痕妊娠超声量化评分系统临床应用的回顾性验证

Retrospective verification of clinical application of ultrasonographic quantitative scoring system in cesarean scar pregnancy

目的回顾性验证超声量化评分系统对行子宫动脉栓塞化疗(UACE)联合清宫术治疗的剖宫产瘢痕妊娠患者病情、预后的预测效能。方法收集剖宫产瘢痕妊娠并接受UACE联合清宫术治疗患者372例,依据超声量化评分系统评分高低将治疗前的剖宫产疤痕妊娠患者分为低危组208例(超声量化评分0~4分)、中危组138例(超声量化评分5~7分)、高危组26例(超声量化评分8~10分)。比较各组临床、超声特点及预后,采用Kappa检验评估中危组与高危组实际治疗方式和预测治疗方式的一致性。结果与中、低危组比较,高危组患者术中出血多、术后更易需要二次治疗、术后包块形成大、包块消失用时较长、术后妊娠概率小(P均<0.05);中危组与低危组上述指标比较,P均<0.05。超声量化评分系统对中危组患者治疗方式预测准确率为98.5%,对高危组患者治疗方式预测准确率为42.3%。结论超声量化评分系统评分高低能反映剖宫产瘢痕妊娠患者的病情,并能预测预后,对评分为5~7分的剖宫产瘢痕妊娠治疗方式的预测效能相对较好。

Objective To validate the predictive effect of ultrasonographic quantitative scoring system on the severity and prognosis of patients with cesarean scar pregnancy(CSP)treated by uterine artery chemoembolization(UACE)in combination with evacuation.Methods The clinical records were retrospectively collected from 372 women who were diagnosed with CSP and treated by UACE in combination with evacuation.According to the score of ultrasonographic quantitative scoring system,the patients with CSP were divided into the low-risk group of 208 cases(score of 0-4),medium-risk group of 138 cases(score of 5-7),and high-risk group of 26 cases(score of 8-10).The clinical and ultrasonographic characteristics among groups were compared.The Kappa test was used to evaluate the consistency of the actual treatment and predictive treatment modalities between the medium-risk group and high-risk group.Results Compared with the medium-risk group and low-risk group,patients in the high-risk group had more intraoperative bleeding during the operation,apt to need salvage treatment after operation,had larger mixed mass formation,need more time to make mixed mass disappear,and had lower postoperative pregnancy rate(all P<0.05);significant difference was found in the above parameters between the low-risk group and the medium-risk(all P<0.05).The accuracy of ultrasonographic quantitative scoring system in predicting the treatment modalities of patients in the medium-risk group was 98.5%,and that of patients in the highrisk group was 42.3%.Conclusion The ultrasonographic quantitative scoring system can reasonably evaluate the severity and prognosis of CSP patients,and it has a relatively good predictive effect on the treatment of patients with a score of 5-7.