剖宫产术后子宫瘢痕妊娠术中出血的危险因素

Analysis of risk factors for intraoperative hemorrhage of cesarean scar pregnancy

目的探讨影响剖宫产术后子宫瘢痕妊娠(CSP)术中出血的相关危险因素。方法回顾性分析2013年1月~2019年1月于南充市中心医院及武汉市妇幼保健院接受手术治疗的410例CSP患者的临床资料,根据术中出血量,分为出血组67例和对照组343例,通过卡方检验或t检验比较出血组和对照组CSP患者的临床特征,采用多因素二分类Logistic回归分析可能影响CSP患者术中出血的可能因素,并绘制受试者工作特征(ROC)曲线对危险因素进行评估。结果出血组与对照组单因素分析表明年龄、CSP病灶清除手术方式、停经天数、妊娠囊最大直径及CSP分型差异有统计学意义(P<0.05),将有统计学意义的因素纳入多因素logistic回归分析显示CSP病灶清除手术方式、妊娠囊最大直径和CSP分型是CSP术中出血的独立危险因素(P<0.05)。ROC分析结果为妊娠囊最大直径、CSP分型及CSP病灶清除手术方式曲线下面积分别为0.77(95%CI=0.713-0.827,P<0.001)、0.75(95%CI=0.686-0.815,P<0.001)和0.438(95%CI=0.273-0.423,P<0.001),妊娠囊最大直径最佳临界值为3cm,灵敏度85.2%,特异度69.1%。结论CSP术中出血受CSP病灶清除手术方式、妊娠囊最大直径及CSP分型影响,妊娠囊直径>3cm和CSPⅢ型是术中出血的高危因素。

Objective To explore the influence of cesarean scar pregnancy(CSP)correlative risk factors of intraoperative blood loss.Methods The clinical data of 410 patients with CSP who received surgical treatment in Nanchong Central Hospital and Wuhan maternal and child health care hospital from January 2013 to January 2019 were retrospectively analyzed.According to the amount of intraoperative blood loss,they were divided into bleeding group(67 cases)and control group(343 cases).The clinical characteristics of CSP patients in the bleeding group and the control group were compared.Multivariate binary logistic regression was used to analyze the possible factors that may affect the intraoperative bleeding in CSP patients,and the receiver operating characteristic(ROC)curve was drawn to evaluate the risk factors.Results Univariate analysis showed that there were significant differences in age,CSP focus clearance operation mode,menopause days,gestational sac maximum diameter and CSP classification between bleeding group and control group(P<0.05).Multivariate logistic regression analysis showed that the surgical method,the largest diameter of gestational sac and the classification of CSP were the independent risk factors of hemorrhage during CSP operation(P<0.05).ROC analysis showed that the area under the curve of the largest diameter of gestational sac,classification of CSP and surgical method of CSP lesion removal were 0.77(95%CI=0.713-0.827,P<0.001),0.75(95%CI=0.686-0.815,P<0.001)and 0.438(95%CI=0.273-0.423,P<0.001),respectively.The best cut-off value of the largest diameter of gestational sac was 3 cm,the sensitivity was 85.2%,and the specificity was 69.1%.Conclusion The bleeding during CSP operation was affected by the operation mode of CSP focus clearance,the maximum diameter of gestational sac and the classification of CSP.Gestational sac diameter>3 cm and CSP typeⅢwere the high risk factors of intraoperative hemorrhage.