天津医药

天津医药 ›› 2023, Vol. 51 ›› Issue (5): 549-552.doi: 10.11958/20221176

• 应用研究 • 上一篇    下一篇

胎囊平均直径在剖宫产瘢痕妊娠清宫术中大出血风险评估中的应用价值

徐杨(), 袁宇△(), 万鑫, 王丽娟   

  1. 天津市天津医院超声科（邮编300211）
  • 收稿日期:2022-07-27 修回日期:2022-12-29 出版日期:2023-05-15 发布日期:2023-05-05
  • 通讯作者: △E-mail:pang5466@sina.com
  • 作者简介:徐杨（1989），女，主治医师，主要从事超声临床诊断学方面研究。E-mail：125134177@qq.com

The application value of average diameter of fetal sac in the risk prediction of massive hemorrhage during cesarean scar pregnancy curettage

XU Yang(), YUAN Yu△(), WAN Xin, WANG Lijuan   

  1. Department of Ultrasound, Tianjin Hospital, Tianjin 300211, China
  • Received:2022-07-27 Revised:2022-12-29 Published:2023-05-15 Online:2023-05-05
  • Contact: △E-mail:pang5466@sina.com

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摘要：

目的 探讨胎囊平均直径对剖宫产瘢痕妊娠（CSP）清宫术中大出血的预测价值。方法 收集117例行清宫术治疗的CSP患者资料，比较大出血组（27例）和无大出血组（90例）的胎囊最大直径、胎囊平均直径、子宫前壁下段肌层厚度、胎囊嵌入类型、胎囊生长方向、胎芽及胎心生长情况、病灶类型、子宫前壁下段外凸情况、病灶处彩色多普勒血流信号分级、年龄及术前绒毛膜促性腺激素（HCG）等12个临床及超声影像指标的差异，探讨胎囊平均直径对CSP清宫术中大出血的预测能力。结果 单因素Logistic回归分析结果显示胎囊最大直径（OR=1.281，95%CI：1.020~1.608）、胎囊平均直径（OR=1.611，95%CI：1.112~2.332）、子宫前壁下段肌层厚度（OR=0.026，95%CI：0.001~0.914）和子宫前壁下段外凸情况（OR=3.081，95%CI：1.262~7.521）是CSP清宫术中大出血的影响因素。逐步Logistic回归分析结果显示胎囊平均直径增加是CSP清宫术中大出血的独立危险因素（OR=1.611，95%CI：1.112~2.331），胎囊平均直径增加对CSP清宫术中大出血的预测曲线下面积（AUC）为0.660（95%CI：0.548~0.773）。结论 胎囊平均直径能增加对CSP清宫术中大出血的预测能力。

关键词: 妊娠, 妊娠,异位, 超声检查, 产后出血, 危险因素, 曲线下面积

Abstract:

Objective To explore the predictive value of average diameter of fetal sac on the massive hemorrhage during the curettage of cesarean scar pregnancy (CSP). Methods The data of 117 CSP patients treated with curettage in Tianjin Hospital were collected. Patients were divided into the two groups, the massive hemorrhage group (n=27) and the no-massive hemorrhage group (n=90). The maximum diameter of fetal sac, the average diameter of fetal sac, the thickness of the lower segment of the anterior wall of uterus, the type of fetal sac insertion, the direction of fetal sac growth, the growth of fetal bud, the growth of fetal heart, the type of focus, the lower segment of the anterior wall of uterus protrusion, the color Doppler blood flow signal classification of the focus, patient age and preoperative human chorionic gonadotropin (HCG) were compared between the two groups. The predictive ability of the average diameter of fetal sac to the massive hemorrhage in CSP curettage was explored. Results The results of single factor Logistic regression analysis showed that the maximum diameter of the fetal sac (OR=1.281, 95%CI: 1.020-1.608), the average diameter of the fetal sac (OR=1.611, 95%CI: 1.112-2.332), the thickness of the lower segment of the anterior wall of the uterus (OR=0.026, 95%CI: 0.001-0.914) and the protrusion of the lower segment of the anterior wall of the uterus (OR=3.081, 95%CI: 1.262-7.521) were the influencing factors of severe hemorrhage in CSP curettage. Stepwise Logistic regression analysis showed that the average diameter of fetal sac was an independent risk factor for massive hemorrhage during CSP curettage (OR=1.611, 95%CI: 1.112-2.331), and the predicted area under the curve (AUC) of the increase of the average diameter of fetal sac for massive hemorrhage after CSP curettage was 0.660 (95%CI: 0.548-0.773). Conclusion The average diameter of fetal sac can increase the prediction ability of massive hemorrhage after CSP curettage.

Key words: pregnancy, pregnancy, ectopic, ultrasonography, postpartum hemorrhage, risk factors, area under curve

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