复发性剖宫产瘢痕部位妊娠的发病影响因素和临床治疗结局分析

Analysis of the Influence Factors and Clinical Outcome of Recurrent Cesarean Scar Pregnancy

目的:研究复发性剖宫产瘢痕部位妊娠(RCSP)发病影响因素和临床治疗结局。方法:选择2013年1月至2020年7月四川省人民医院收治的1150例剖宫产瘢痕部位妊娠CSP患者为研究对象,随访18~108个月,追踪患者术后再次妊娠RCSP的发生率和治疗情况,并采用单因素分析和多因素Logistic回归分析RCSP的发病影响因素。结果:1150例CSP患者失访166例,失访率14.43%,术后妊娠141例,最终纳入研究分组的135例,根据再次妊娠是否发生CSP分为正常妊娠组114例和RCSP组21例,21例RCSP患者均成功清除妊娠病灶,1例术中发生大出血,失血量约1000 ml,术中结扎双侧子宫动脉,预后良好。多因素分析结果显示多次人工流产(≥3次)为RCSP的独立危险因素(OR=11.34,P<0.05),子宫切口憩室修复术是RCSP的保护性因素(OR=0.44,P<0.05)。结论:RCSP总体治疗结局较好,无生育需求的育龄期女性均应落实高效避孕措施,减少人工流产,对于CSP术中发现子宫切口肌层菲薄且有再生育需求的患者建议行子宫切口憩室修复术。

Objective:To investigate the treatment outcomes of recurrent cesarean scar pregnancy(RCSP)and the factors influencing its morbidity.Methods:A total of 1150 patients with cesarean scar pregnancy(CSP)admitted to Sichuan Provincial People′s Hospital between January 2013 and July 2020 were selected for the study and followed up for 18-108 months to track the incidence and treatment of RCSP at the time of re-pregnancy after cesarean section,and univariate analysis and multivariate Logistic regression analysis were used to analyze the factors influencing the development of RCSP.Results:Among 1150 CSP patients,166 were lost to follow-up,with a loss rate of 14.43%,and 141 were pregnant after surgery.According to the study criteria,a total of 135 cases were divided into the normal pregnancy(n=114)and RCSP(n=21)groups,of whom all successfully cleared the pregnancy lesion.Intraoperative hemorrhage occurred in one of the 21 cases with a blood loss of about 1000 ml,and the prognosis was favorable with ligation of bilateral uterine arteries.Multivariate Logistic analysis showed that multiple artificial abortions(≥3)were the independent risk factor for RCSP(OR=11.34,P<0.05),and repair of the diverticulum of the uterine incision was a protective factor for RCSP(OR=0.44,P<0.05).Conclusions:The overall treatment outcomes of RCSP were good,and women of childbearing age without fertility needs should implement efficient contraception and reduce abortions.For patients with thin myometrium of the uterine incision found during CSP operation and with the need for reproduction,repair of the diverticulum of the uterine incision is recommended.