摘要
背景现行剖宫产瘢痕妊娠(CSP)分型依据仅参照超声影像特点,目前尚缺乏该分型标准下不同类型CSP病例临床特点的分析总结。目的探讨不同类型CSP的病例特点及诊治差异。方法纳入北京大学第三医院妇产科2014年7月—2022年6月收治的CSP患者共862例为研究对象,根据超声分型标准分为Ⅰ型、Ⅱ型、Ⅲ型组,并对其临床特点及诊治指标进行回顾性分析。结果本研究CSP患者中Ⅰ型组占36.5%(315/862),Ⅱ型组占53.1%(458/862),Ⅲ型组占10.3%(89/862)。3组患者的年龄、孕产史、既往宫腔手术史比例比较,差异均无统计学意义(P>0.05)。CSP患者中腹痛发生率为24.2%(209/862),阴道出血发生率为65.0%(560/862)。3组CSP患者腹痛及阴道出血发生率比较,差异均无统计学意义(P=0.261、0.062)。Ⅲ型组患者诊断时停经时间为55(46,64)d,妊娠物中位径线长29.6(19.1,43.3)mm,术前血β-人绒毛膜促性腺激素(β-HCG)水平为60673(17164,122203)mU/mL,需辅助药物杀胚治疗、腹腔镜监视下手术、子宫动脉阻断率分别为27.0%(24/89)、33.7%(30/89)、32.6%(29/89),手术时长101(67,125)min,住院时间4(3,7)d,治疗花费11933.7(8760.7,15250.6)元,术后24 h累计出血量、出血≥200 mL发生率及输血率分别为83(33,178)mL、24.7%(22/89)、7.9%(7/89),均高于其他两组(P<0.001)。所有患者持续性CSP发生率为3.1%(27/862),3组持续性CSP发生率比较,差异无统计学意义(χ^(2)=3.353,P=0.187)。结论不同类型CSP患者的年龄、孕产史、既往宫腔手术史及腹痛、阴道出血等临床特点无明显差异。Ⅰ型和Ⅱ型患者治疗侵入性较小,Ⅲ型患者的医疗资源消耗较多,对多学科团队及个体化管理有较高要求。不同类型患者经规范管理,其治疗预后均较理想。
Background The current classification of cesarean scar pregnancy(CSP)is only based on the ultrasonic characteristics.At present,there is a lack of analysis and summarization of the clinical characteristics of different types of CSP cases under this classification criteria.Objective To investigate the clinical characteristics and management variance of different types of CSP.Methods A total of 862 patients with CSP admitted to the Department of Obstetrics and Gynecology,Peking University Third Hospital from July 2014 to June 2022 were enrolled and divided into the typeⅠ,typeⅡand typeⅢgroups.The clinical characteristics and indicators of diagnosis and treatment were analyzed retrospectively.Results Among the total CSP patients,36.5%(315/862)were typeⅠ,53.1%(458/862)were typeⅡ,and 10.3%(89/862)were typeⅢ.The incidence of abdominal pain was 24.2%(209/862)and vaginal bleeding was 65.0%(560/862)in CSP patients.There was no statistically significant difference in the age,history of pregnancy and childbirth,and proportion of previous uterine cavity surgery among the three groups of patients(P>0.05).There was no significant difference in abdominal pain(P=0.261)and vaginal bleeding(P=0.062)among the three groups.In typeⅢpatients,the average gestational age was 55(46,64)days,the average diameter of gestational mass was 29.6(19.1,43.3)mm,and the serumβ-HCG level was 60673(17164,122203)mU/mL at diagnosis.The proportion of patients who needed adjuvant pharmacologic embryocidal therapy,laparoscopic surgery and uterine artery occlusion was 27%(24/89),33.7%(30/89)and 32.6%(29/89),respectively.The operation duration was 101(67,125)min,the hospitalization duration was 4(3,7)days,and the treatment cost was 11933.7(8760.7,15250.6)CNY for typeⅢpatients.The accumulated bleeding volume within 24 hours after surgery,the proportion of patients with perioperative bleeding≥200 mL and requiring blood transfusion was 24.7%(22/89)and 7.9%(7/89)in typeⅢpatients,respectively,which were higher than the other two groups(P<0.001).The incidence of persistent CSP was 3.1%(27/862)in all patients,and there was no significant difference among the three groups(χ^(2)=3.353,P=0.187).Conclusion There is no significant difference in age,maternal history,gravidity and parity,and clinical characteristics such as abdominal pain and vaginal bleeding in patients with different types of CSP.The treatment of typeⅠand typeⅡpatients is less invasive and consumes less medical resources,while typeⅢpatients consume more medical resources and have high requirements for multidisciplinary team and individualized management.The prognosis of all three types of patients is ideal after standardized management.
作者
王超
侯征
李华军
李蓉
乔杰
WANG Chao;HOU Zheng;LI Huajun;LI Rong;QIAO Jie(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China;National Clinical Research Center for Obstetrics and Gynecology(Peking University Third Hospital),Beijing 100191,China;Key Laboratory of Assisted Reproduction(Peking University),Ministry of Education,Beijing 100191,China;Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology(Peking University Third Hospital),Beijing 100191,China)
出处
《中国全科医学》
北大核心
2024年第12期1475-1479,1486,共6页
Chinese General Practice
基金
国家重点研发计划“生育健康及妇女儿童健康保障”重点专项(2022YFC2702500)。
关键词
剖宫产术
瘢痕妊娠
体征和症状
治疗
预后
Cesarean section
Scar pregnancy
Signs and symptoms
Treatment
Prognosis
