剖宫产术后子宫瘢痕妊娠宫腔镜治疗结局的影响因素分析

Analysis of Influencing Factors for Outcome of Hysteroscopic Treatment in Cesarean Scar Pregnancy

目的:回顾性分析剖宫产术后子宫瘢痕妊娠(CSP)宫腔镜治疗结局的影响因素。方法:选取204例行宫腔镜治疗的CSP患者,分为手术成功组和手术失败组。收集患者的相关临床资料,采用Logistic回归分析宫腔镜手术治疗结局的影响因素。结果:与手术失败组相比,手术成功组剖宫产次数更少,孕周更短,术前β-绒毛膜促性腺激素(β-hCG)、孕囊直径和子宫动脉收缩期峰值血流速度(PSV)更低,距离上次剖宫产时间更长,子宫瘢痕处肌层更厚,子宫动脉血管阻力指数(RI)更高(均P<0.05)。Logistic回归分析显示,剖宫产2次、孕周>53 d、β-hCG>38228.90 mIU/mL、孕囊直径>3.3 cm、子宫动脉PSV>57.3 cm/s、子宫动脉RI≤0.385是CSP宫腔镜治疗失败的危险因素(均P<0.05);距离上次剖宫产时间≥5年、子宫瘢痕处肌层厚度>0.29 cm是CSP宫腔镜治疗成功的有利因素(均P<0.05)。结论:剖宫产史、孕周、β-hCG、孕囊直径、子宫动脉PSV、子宫动脉RI是CSP宫腔镜治疗结局的影响因素。

Objective:To analyze the influencing factors for outcome of hysteroscopic treatment in cesarean scar pregnancy(CSP).Methods:A total of 204 cases of CSP treated with hysteroscopic surgery were divided into the successful group and the failed group.The relevant clinical data were collected,and the influencing factors for the outcome of hysteroscopic surgery were analyzed using Logistic regression method.Results:Compared with the failed group,the patients in the successful group have fewer cesarean sections,shorter gestational age,lower level of preoperativeβ-human chorionic gonadotropin(β-hCG),gestational capsule diameter and peak systolic velocity(PSV)of the uterine artery,longer time since last cesarean section,thicker myometrium at uterine scar,and higher uterine artery resistance index(RI)(all P<0.05).Logistic regression analysis suggested that cesarean section delivered 2 times,gestational weeks more than 53 days,level ofβ-hCG more than 38228.90 mIU/mL,diameter of gestational capsule more than 3.3 cm,PSV of uterine artery more than 57.3 cm/s,and RI of uterine artery less than or equal to 0.385 were risk factors for failed treatment of CSP with hysteroscopic surgery(all P<0.05).The time since last cesarean section more than or equal to 5 years,and the thickness of muscular layer at uterine scar more than 0.29 cm were the favorable factors for successful treatment of CSP with hysteroscopic surgery(both P<0.05).Conclusion:Cesarean section history,gestational age,β-hCG,gestational capsule diameter,PSV and RI of uterine artery are the influencing factors for the outcome of hysteroscopic treatment of CSP.