胎盘植入产妇子宫切除的影响因素分析

Analysis of influencing factors of hysterectomy in patients with placenta accreta spectrum disorders

目的:分析胎盘植入性疾病子宫切除的影响因素,探讨胎盘植入性疾病的最佳处理方式,降低子宫切除的比例。方法:回顾性分析2015年1月1日至2021年12月31日于四川省医学科学院·四川省人民医院行剖宫产终止妊娠的269例胎盘植入性疾病产妇的临床资料,分为子宫切除组(研究组)和子宫未切除组(对照组),比较2组患者的一般情况、产前出血情况(孕早期出血、孕中晚期出血)、胎盘植入类型、凶险性前置胎盘情况、妊娠并发症(妊娠期高血压疾病、妊娠期糖尿病、妊娠期肝内胆汁淤积症)、术前是否影像诊断胎盘植入(超声或核磁共振)、术前腹主动脉球囊阻断、是否急诊手术、终止孕周、新生儿体质量等指标有无差异;对2组患者进行单因素和多因素logistic回归分析。结果:2组患者孕次、产次、既往剖宫产次数、宫腔粘连史、孕中晚期出血、前置胎盘情况、术前影像诊断胎盘植入、腹主动脉球囊阻断、孕周、新生儿体质量有统计学差异(P<0.05)。多因素logistic回归分析显示,宫腔粘连史、胎盘植入类型、凶险性前置胎盘是胎盘植入产妇子宫切除的独立危险因素(OR>1,P<0.05),孕中晚期出血、终止孕周是子宫切除的独立保护性因素(OR<1,P<0.05)。结论:既往宫腔粘连、胎盘植入深度越深以及凶险性前置胎盘增加了胎盘植入患者子宫切除的危险,而孕中晚期出血、适当延长孕周降低产妇子宫切除的风险。

Objective:To investigate the factors influencing hysterectomy on patients with placenta accreta spectrum disorders(PAS),explore the best treatment of PAS, and reduce the proportion of hysterectomy. Methods:A retrospective study was conducted among269 pregnant women who diagnosed with PAS and underwent cesarean section(CS)between January 1, 2015 and December 31, 2021in Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital,and they were divided into hysterectomy group(study group)and non-hysterectomy group(control group). The related factors of hysterectomy were compared between the two groups,including basic characteristics,antepartum hemorrhage(early pregnancy bleeding,bleeding in the second and third trimester of pregnancy),type of placenta accreta,pernicious placenta previa(PPP),pregnancy complications(gestational hypertension,gestational diabetes,intrahepatic cholestasis of pregnancy),image diagnosis of PAS before the operation(ultrasound or nuclear magnetic resonance),abdominal aorta balloon occlusion,emergency CS,infant birth weight,position of fetus,and so on. Univariate and multivariate logistic analyses were used for statistical analysis. Results:There were significant differences between the two groups in pregnancy times,parity,previous CS times,intrauterine adhesion history,second and third trimester bleeding,PPP,preoperative imaging diagnosis of placenta accreta,abdominal aortic balloon occlusion,gestational age and newborn weight(P<0.05). In multivariate logistic analysis,history of interuterine adhesions,type of placenta accreta and PPP were independent risk factors affecting hysterectomy(OR>1,P<0.05),and middle and late antepartum hemorrhage and CS were independent protective variables affecting hysterectomy(OR<1,P<0.05). Conclusion:Women with PAS complicated with history of interuterine adhesions,PPP and more extent of placenta accreta have significantly higher risks of hysterectomy than women without hysterectomy,and middle and late antepartum hemorrhage and longer gestational age can reduce the risk of hysterectomy.