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目的探讨高危型剖宫产瘢痕妊娠(high risk-cesarean scar pregnancy,HR-CSP)影响其治疗结局的危险因素。方法采用回顾性病例对照研究方法,收集2008年3月至2014年12月近7年第三军医大学西南医院妇科住院且腹腔镜下成功治疗剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)患者105例,其中30例行腹腔镜病灶清除术为高危组,75例行腹腔镜监视下清宫术为低危组。提取所有出院病历中与研究相关的患者基本资料及手术记录。采用SPSS 17.0统计软件进行分析,确定高危型CSP的独立危险因素、相对危险度(odds ratio,OR)及95%可信区间(95%confidence interval,95%CI)。结果高危组与低危组停经时间(t=-4.485,P<0.01)、超声测量病灶最大径线(t=-5.096,P<0.01)、手术时间(t=-11.888,P<0.01)、术中出血量(t=-5.110,P<0.01)、住院天数(t=-3.290,P=0.001,P<0.05)、超声分型:孕囊型/包块型(χ2=35.188,P<0.01)、胎血管搏动:有/无(χ2=5.392,P=0.020,P<0.05)差异有统计学意义;超声测量病灶最大径线(OR=1.042,95%CI:1.001~1.085)、超声分型:孕囊型/包块型(OR=14.122,95%CI:3.277~60.860)为高危型CSP发生的独立危险因素。结论剖宫产瘢痕妊娠时超声测量病灶最大径线及超声类型是影响剖宫产切口瘢痕妊娠治疗结局的独立危险因素。
Objective To investigate the risk factors of high risk cesarean scar pregnancy (HR-CSP) affecting its outcome. Methods A retrospective case-control study was conducted in our hospital from March 2008 to December 2014. The patients with cesarean scar pregnancy (cSP) underwent laparoscopic cesarean scar pregnancy Cases, of which 30 cases of laparoscopic debridement for the high-risk group, 75 cases of laparoscopic monitoring under the curettage group for the low-risk group. All patient-related medical records and surgical records were extracted from all discharged medical records. The independent risk factors, odds ratio (OR) and 95% confidence interval (95% confidence interval) of high risk CSP were determined by SPSS 17.0 statistical software. Results The duration of menopause (t = -4.485, P <0.01) in high-risk group and low-risk group was higher than that in low risk group (t = -4.485, The intraoperative bleeding (t = -5.110, P <0.01), hospital stay (t = -3.290, P = 0.001, P <0.05) 0.01). There was a significant difference between the two groups (P = 0.020, P <0.05). The largest diameter of the lesion (OR = 1.042,95% CI: 1.001 ~ 1.085) Type: gestational sac type / mass type (OR = 14.122,95% CI: 3.277 ~ 60.860) is an independent risk factor for high-risk CSP. Conclusion The maximum diameter of the lesions and the type of ultrasonography during cesarean scar pregnancy are independent risk factors for the treatment outcome of cesarean scar incision pregnancy.