影响子宫动脉栓塞术在剖宫产疤痕妊娠中应用的因素分析

目的：探讨子宫动脉栓塞术（UAE）在剖宫产疤痕妊娠（CSP）治疗中的应用效果及其影响因素分析。 方法：选取2012年12月至2017年6月在我院拟采用药物保守治疗的CSP患者76例。其中26例采用肌内注射甲氨蝶呤+清宫术治疗（A组），50例采用甲氨蝶呤+UAE+清宫术治疗（B组）。比较两组的一般资料及治疗结果，采用多因素Logistic回归模型分析影响采用UAE介入治疗的因素，并进一步应用ROC曲线得出最佳临界值。 结果：单因素分析显示：两组的年龄、孕次、产次、剖宫产史时间、血清β-HCG值比较差异无统计学意义。B组的停经时间较A组长（53.6±20.2）d vs.（48.7±17.2）d]，孕囊比A组大（3.87 ±1.58）mm vs.（3.19±2.06）mm]，疤痕肌层厚度比A组薄（1.65±1.12）mm vs.（2.97±1.24）mm]、疤痕妊娠分型中Ⅱ型比例较高（66% vs. 35%），与A组差异均有统计学意义（P<0.05）；Logistic回归分析显示：停经时间长、疤痕肌层厚度薄是影响采用UAE治疗CSP的独立危险因素。ROC曲线分析显示，妊娠时间≥51 d，疤痕肌层厚度≤2.7 mm为选择UAE的最佳临界值（ROC曲线下面积分别为0.813和0.808）。 结论：UAE可有效防治剖宫产疤痕妊娠保守治疗中的大出血；尤其对停经时间≥51 d，疤痕厚度≤2.7 mm的患者更具有重要的临床价值。

Factor analysis on uterine artery embolization in treatment of caesarean scar pregnancy

Objective:To explore the application and influential factors of uterine artery embolization (UAE) in the treatment of caesarean scar pregnancy (CSP) . Methods:The retrospective study included 76 cases of CSP who planed to accept conservative therapy (dilation and curettage combined with MTX injected intramuscularly) , including 26 patients treated with effective treatment (group A) and 50 patients treated with Methotrexate+ UAE (group B) . The patients' clinical parameters, adverse reactions and complications were recorded. Univariate analysis and multivariate logistic regression model were used to analyze the factors of choosing UAE, and the receiver operating characteristic curve (ROC) was further utilized to gain the optimal cutoff. Results:The univariate analysis showed that there was no significant difference in age, parity, parity, history of cesarean section and serum β-HCG level between the two groups. The menolipsis time (P=0.012) , gestational sac size (P=0.031) , thickness of scar myometrium (P=0.002) and scar types (P=0.036) in group A were significantly different from those in group B. The multivariate logistic regression model showed that the menstruation time and thickness of scar myometrium were independent factors of choosing UAE. The optimal cutoff for menolipsis time and thickness of scar myometrium were 51 d and 2.7 mm, respectively (the areas under their corresponding ROC were 0.813 and 0.808) . Conclusion:UAE is effective in preventing massive hemorrhage during treatment of CSP, especially for the cases with menolipsis time ≥51 d and thickness of scar myometrium ≤2.7 mm.