摘要
目的分析持续性剖宫产瘢痕妊娠(persistent cesarean scar pregnancy,PCSP)患者的临床资料,了解导致其高危因素及再次妊娠结局。方法收集2018年2月至2021年5月在湖北省妇幼保健院住院的清宫术后发生PCSP的45例患者为PCSP组,其中42例为腹腔镜下妊娠物清除术及子宫瘢痕修补术;纳入同期确诊为剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的612例患者为对照组,其中初次治疗采用清宫术成功的514例为清宫组;98例腹腔镜手术初次治疗成功患者作为腹腔镜治疗组。比较各组患者的临床表现、影像学表现及治疗结局。结果PCSP组与清宫组妊娠次数[(5.07±2.51)次,(1.56±0.06)次]、流产次数[(2.49±1.94)次,(1.85±0.06)次]、术前β-hCG值[(105000.93±75375.63)IU/L,(46562.16±2268.19)IU/L]、术前孕囊直径[(3.86±1.51)cm,(2.72±0.06)cm]和肌层厚度[(0.23±0.17)cm,(0.36±0.01)cm]比较,差异均有统计学意义(P<0.05);多因素分析显示,两组患者术前β-hCG值、术前孕囊直径和肌层厚度比较,差异均有统计学意义(P<0.05);PCSP组中42例腹腔镜下手术治疗成功率为100%(42/42),PCSP组再次妊娠时RCSP发生率低于清宫组及腹腔镜治疗组[0%(0/10),19.44%(14/72),27.27%(3/11)],但差异均无统计学意义(P=0.266)。结论清宫术前β-hCG值、术前孕囊直径、肌层厚度是导致PCSP的独立危险因素,在腹腔镜下切除PCSP病灶安全有效,其再次妊娠时发生RCSP的概率低。
Objective To analyze the clinical data of patients with persistent cesarean section scar pregnancy(PCSP)in Hubei Maternal and Child Health Hospital in recent five years,to identify the high risk factors of PCSP and to understand the second pregnancy outcome of PSCP patients.Methods The data of 45 cases of PCSP after uterine curettage in Hubei Maternal and Child Health Hospital from February 2018 to May 2021 were included as PCSP group,including 42 cases of laparoscopic pregnancy removal and uterine scar repair,and 612 patients diagnosed with cesarean scar pregnancy(CSP)during the same period were included as the control group.Among them,514 patients who successfully underwent curettage for the first treatment were included in the curettage group;98 patients with successful initial laparoscopic surgery were selected as the laparoscopic treatment group The clinical manifestations,imaging findings and treatment results of these patients were compared.Results The number of pregnancies in PCSP group and the curettage group was[(5.07±2.51),(1.56±0.06)],the number of miscarriages was[(2.49±1.94),(1.85±0.06)],and preoperativeβ-hCG values were[(105000.93±75375.63)IU/L,(46562.16±2268.19)IU/L],the preoperative gestational sac diameter was[(3.86±1.51)cm,(2.72±0.06)cm],and the muscle layer thickness was[(0.23±0.17)cm,(0.36±0.01)cm],respectively.There was a statistically significant difference between the two groups in the above indicators(P<0.05).Multivariate analysis of the above factors showed that there were significant differences in preoperativeβ-hCG value,preoperative gestational sac diameter and muscle layer thickness between the two groups(P<0.05).42 cases of PCSP were treated by laparoscopy,and the success rate was 100%(42 versus 42).The incidence of recurrent cesarean scar pregnancy(RCSP)in the study group was lower than that in the curettage group and the laparoscopic treatment group[0%(0 versus 10),19.44%(14 versus 72),27.27%(3 versus 11)],but there was no significant difference(P=0.266).Conclusion The
作者
雷晓静
杜欣
冯同富
刘玉立
刘璐
乐芳舒
张媛
LEI Xiaojing;DU Xin;FENG Tongfu;LIU Yuli;LIU Lu;LE Fangshu;ZHANG Yuan(Wuhan University of Science and Technology,Wuhan 430065,China;Department of Maternity,Hubei Maternal and Child Health Hospital,Wuhan 430070,China)
出处
《中国妇产科临床杂志》
CSCD
2023年第6期609-613,共5页
Chinese Journal of Clinical Obstetrics and Gynecology
基金
湖北省卫生健康委员会(WJ2019H190)。
关键词
持续性剖宫产瘢痕妊娠
腹腔镜手术
清宫术
肌层厚度
孕囊直径
persistent cesarean scar pregnancy
laparoscopic surgery
dilatation and curettage
thickness of muscle layer
maximum gestational sac size
