剖宫产瘢痕妊娠切除术后复发风险及其相关预测因素分析

Analysis of the recurrence risk after cesarean scar pregnancy resection and its related predictive factors

目的探讨剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)切除术后复发风险及其相关预测因素。方法选择2016年12月至2019年1月保定市妇幼保健院294例CSP患者为研究对象,分析患者一般资料(年龄、既往剖宫产次数、人流次数、子宫下段厚度、是否合并糖尿病等)、临床资料[手术方式、手术出血量、术后血人绒毛膜促性腺激素(human chorionic gonadotrophin,hCG)恢复正常时间、月经恢复时间等],根据再次妊娠情况将复发性CSP(recurrent cesarean scar pregnancy,RCSP)作为RCSP组,宫内正常妊娠作为对照组,采用多因素回归模型分析影响CSP切除术后再次妊娠结局的相关因素。结果排除3例失访,151例未妊娠,最终纳入RCSP组28例,对照组112例。两组年龄、合并糖尿病、孕囊直径、既往剖宫产次数、人流次数、CSP分型、子宫下段厚度、手术方式、术后血hCG恢复正常时间、月经恢复时间比较,差异有统计学意义(P<0.05),两组CSP切除孕周、麻醉方式、手术出血量比较,差异无统计学意义(P>0.05)。经多因素Logistic回归模型分析显示,既往剖宫产次数、CSP分型、手术方式是影响CSP切除术后RCSP发生的独立危险因素,子宫下段厚度是RCSP的独立保护因素(OR=0.136,P<0.001),其中,子宫下段厚度与RCSP风险呈明显非线性关系(P=0.004)。结论既往剖宫产次数、CSP分型、手术方式是CSP切除术后RCSP发生的危险因素,子宫下段厚度是RCSP的独立保护因素。

Objective To explore the recurrence risk after cesarean scar pregnancy(CSP)resection and its related predictive factors.Methods Selected 294 CSP patients from Baoding Maternal and Child Health Hospital from December 2016 to January 2019 as the research objects,and analyzed their general data(age,past cesarean section times,abortion times,thickness of lower uterus,diabetes,etc.),clinical data(method of operation,surgical blood loss,postoperative blood human chorionic gonadotropin recovery time,menstruation recovery time,etc.).According to the situation of re-pregnancy,recurrent CSP(RCSP)was used as the RCSP group,and the normal intrauterine pregnancy was used as the control group.The multivariate regression model was used to analyze the related factors that affect the outcome of re-pregnancy after CSP resection.Results 3 cases were excluded from follow-up,151 cases were not pregnant,and 28 cases were included in the RCSP group and 112 cases in the control group.There were statistically significant differences in age,combined diabetes,diameter of gestational sac,previous cesarean section times,abortion times,CSP classification,thickness of lower uterus,operation method,postoperative blood human chorionic gonadotropin return to normal time,menstrual recovery time(P<0.05).There were no statistically significant differences between the two groups of CSP resection gestational weeks,anesthesia methods,and surgical blood loss(P>0.05).Multivariate logistic regression model analysis showed that the number of past cesarean sections,CSP classification,and surgical methods were independent risk factors for the occurrence of RCSP after CSP resection,and the thickness of the lower uterus was an independent protective factor for RCSP(OR=0.136,P<0.001),the thickness of the lower uterine segment and the risk of RCSP showed a significant non-linear relationship(P=0.004).Conclusion The number of past cesarean sections,CSP classification,and surgical methods are risk factors for RCSP after CSP resection,and the thickness of the lower uterus is an independent protective factor for RCSP.