超声引导下瘢痕妊娠清宫术中出血量的影响因素分析

INFLUENCING FACTORS FOR INTRAOPERATIVE BLOOD LOSS DURING ULTRASOUND-GUIDED CURETTAGE FOR CESA-REAN SCAR PREGNANCY

目的分析超声引导下瘢痕妊娠清宫术中出血量的相关影响因素,为临床治疗方案的制定提供依据。方法选取2018年1月—2021年6月我院和青岛大学附属医院收治的瘢痕妊娠病人76例。所有病人均在术前行经阴道彩色多普勒超声检查,手术方式是超声引导下清宫术。记录病人年龄、剖宫产次数、距末次剖宫产时间、人工流产次数及术中出血量,并记录术前超声影像学特征(孕囊最大直径、子宫前壁下段肌层厚度、彩色多普勒血流成像Adler分级)。应用单因素和多因素Logistic回归模型分析超声引导下瘢痕妊娠清宫术中出血量的影响因素。结果单因素分析显示,超声引导下清宫术中出血量与Adler分级、孕囊最大直径和子宫前壁下段肌层厚度相关,而与年龄、剖宫产次数、人工流产次数及距末次剖宫产时间均无关。多因素分析显示,Adler分级(Ⅰ级:OR=0.011,P<0.001;Ⅱ级:OR=0.141,P=0.035)、孕囊最大直径(OR=2.846,P=0.007)和子宫前壁下段肌层厚度(OR=0.004,P=0.041)均是影响超声引导下清宫术中出血量的因素。结论Adler分级、孕囊最大直径和子宫前壁下段肌层厚度是超声引导下瘢痕妊娠清宫术中出血量的危险因素。术前经阴道彩色多普勒超声准确测量孕囊最大直径和子宫前壁下段肌层厚度,同时结合彩色多普勒血流Alder分级法半定量评估血流,有助于临床治疗方案的制定,避免术中大出血。

Objective To investigate the influencing factors for intraoperative blood loss during ultrasound-guided curettage for cesarean scar pregnancy(CSP),and to provide a basis for developing clinical treatment regimens.Methods A total of 76 CSP patients who were admitted to our hospital and The Affiliated Hospital of Qingdao University from January 2018 to June 2021 were enrolled.All patients underwent transvaginal color Doppler ultrasound examination before surgery,and the surgical procedure was ultrasound-guided curettage.Related data were recorded,including age,the number of cesarean sections,the interval between current CSP and the last cesarean section,the number of induced abortions,intraoperative blood loss,and preoperative radiological features(the maximum diameter of gestational sac,muscular layer thickness of the anterior uterine wall,and Adler grade on color Doppler flow imaging).Univariate and multivariate logistic regression analyses were used to investigate the risk factors for intraoperative blood loss during ultrasound-guided curettage for CSP.Results The univariate analysis showed that intraoperative blood loss during ultrasound-guided curettage for CSP was associated with Adler grade,the maximum diameter of gestational sac,and muscular layer thickness of the lower anterior uterine wall,while it was not associated with age,the number of cesarean sections,the number of induced abortions,and the interval between current CSP and the last cesarean section.The multivariate regression analysis showed that Adler grade(gradeⅠ:OR=0.011,P<0.001;gradeⅡ:OR=0.141,P=0.035),the maximum diameter of gestational sac(OR=2.846,P=0.007),and muscular layer thickness of the lower anterior uterine wall(OR=0.004,P=0.041)were influencing factors for intraoperative blood loss during ultrasound-guided curettage for CSP.Conclusion Adler grading,the maximum diameter of gestational sac,and muscular layer thickness of the lower anterior uterine wall are the risk factors for intraoperative blood loss during ultrasound-guided curettage for CSP.It is necessary to perform an accurate mea-surement of the maximum diameter of gestational sac and muscular layer thickness of the lower anterior uterine wall by preoperative transvaginal color Doppler ultrasound and a semi-quantitative evaluation of blood flow by Adler grade on color Doppler flow imaging,so as to support the development of clinical treatment regimens and avoid massive intraoperative blood loss.