宫腹腔镜治疗剖宫产瘢痕妊娠效果影响因素分析及其预测效力

Analysis of the factors influencing the treatment effect of hysteroscopic and laparoscopic surgery for treating patients with cesarean scar pregnancy and their predictive efficacy for the treatment effect

目的:探讨剖宫产瘢痕妊娠(CSP)患者宫腹腔镜治疗效果的影响因素及预测效力。方法:选取2019年1月-2024年1月本院100例CSP患者临床资料,均行宫腹腔镜手术治疗,依据治疗效果分为有效组(83例)、无效组(17例)。收集患者一般资料、阴道超声指标、术前β-人绒毛膜促性腺激素(β-hCG)等临床资料;二元logistic回归分析筛选影响CSP患者宫腹腔镜治疗效果的因素,受试者操作特征(ROC)曲线评价影响因素对宫腹腔镜治疗无效的预测效能。结果:单因素分析显示,剖宫产产次、孕周、瘢痕妊娠类型、孕囊体积、子宫瘢痕处肌层厚度、瘢痕处血流分级、术前血清β-hCG水平与CSP患者宫腹腔镜治疗效果有关(P<0.05)。logistic多因素显示,瘢痕妊娠类型为外生型(OR=4.300)、孕囊体积大(OR=1.674)、瘢痕处血流分级为Ⅲ级(OR=2.811)、子宫瘢痕处肌层厚度小(OR=0.070)、术前血清β-hCG水平高(OR=1.003)是CSP患者宫腹腔镜治疗效果不佳的影响因素(P<0.05)。ROC分析显示,上述影响因素均对CSP患者宫腹腔镜治疗无效有一定预测效能,曲线下面积(AUC)分别为0.707、0.760、0.727、0.872、0.938。结论:瘢痕妊娠类型、孕囊体积、瘢痕处血流分级、子宫瘢痕处肌层厚度、术前血清β-hCG水平均可影响CSP患者宫腹腔镜治疗效果,且均有一定预测效力,临床可据此早期识别危险人群,对应处理以改善患者预后。

Objective:To investigate the factors influencing the treatment effect of hysteroscopic and laparoscopic surgery for treating patients with cesarean scar pregnancy(CSP),and to study the predictive efficacy of these influence factors for the treatment effect.Methods:The clinical data of 100 patients with CSP whom were treated with hysteroscopic and laparoscopic surgery in the hospital from January 2019 to January 2024 were selected in this study.All the patients were divided into 83 cases with effective treatment in group A and 17 cases with ineffective treatment in group B according to the treatment results.The general data,the vaginal ultrasound index value,the preoperativeβ-human chorionic gonadotropin(β-hCG)level and other clinical data of the patients in the two groups were collected.Binary Logistic regression analysis was used to screen the factors affecting the efficacy of hysteroscopic and laparoscopic surgery for treating patients with CSP.Receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of the influencing factors on the ineffective treatment of hysteroscopic and laparoscopic surgery.Results:Univariate analysis showed that the number of cesarean section,the gestational weeks,the type of scar pregnancy,the gestational sac volume,the muscular layer thickness of uterine scar,the blood flow classification of scar and the preoperative serumβ-hCG level of the patients with CSP were related to their treatment effect by hysteroscopic and laparoscopic surgery(P<0.05).Logistic multivariate analysis showed that the exogenous type of scar pregnancy(OR=4.300),the large gestational sac volume(OR=1.674),the gradeⅢblood flow of the scar(OR=2.811),the less muscular thickness of the scar(OR=0.070)and the high preoperative serumβ-hCG level(OR=1.003)of the patients with CSP were the influencing factors of their ineffective treatment by hysteroscopic and laparoscopic surgery(P<0.05).ROC analysis showed that all the above influencing factors had certain predictive efficacy for the ineffective treatment of the patients with CSP by hysteroscopic and laparoscopic surgery,and the area under the curve(AUC)of all the above influencing factors for predicting the efficacy of hysteroscopic and laparoscopic surgery were 0.707,0.760,0.727,0.872and 0.938,respectively.Conclusion:The type of scar pregnancy,the gestational sac volume,the blood flow classification of scar,the muscular layer thickness of uterine scar and the preoperative serumβ-hCG level of the patients with CSP are all infecting their effect of hysteroscopic and laparoscopic surgery,and which all have certain predictive values for the effect of hysteroscopic and laparoscopic surgery.The patients with CSP and the risk of the ineffective treatment by hysteroscopic and laparoscopic surgery can be identified based on these influence factors early,and the corresponding measure should be conducted to improve the prognosis of the patients.