剖宫产瘢痕妊娠患者侧支动脉的形成及其危险因素分析

目的：探讨剖宫产瘢痕妊娠行子宫动脉栓塞术时发现侧支动脉形成的概率及其危险因素。方法：分析2009年1月至2014年6月在中南大学湘雅三医院进行子宫动脉栓塞术的剖宫产瘢痕妊娠患者资料，并根据有无侧支动脉的形成将患者分成有侧支动脉组(34例)及无侧支动脉组(对照组，110例)。记录可能引起侧支动脉形成的各项参数，分别用t检验、χ2检验及Fisher精确检验法进行单因素分析，对P<0.20的参数进行logistic多因素分析，计算其相对危险度(RR)及95%可信区间(95%CI)。结果：有侧支动脉形成的剖宫产瘢痕妊娠患者的发病率为23.4%。单因素及logistic多因素回归分析表明：胎盘前置(RR=78.556，95%CI：2.869~2 150.651，P=0.010)、盆腔炎症(RR=6.633，95% CI：1.595~27.592，P=0.009)、人流手术史(RR=18.381，95%CI：1.683~200.752，P=0.017)及子宫肌瘤或腺肌症(RR=12.580，95%CI：1.004~157.550， P=0.050)与剖宫产瘢痕妊娠侧支动脉的形成密切相关。结论：前置胎盘、盆腔炎症、人流手术史以及子宫肌瘤或腺肌症是剖宫产瘢痕妊娠患者侧支动脉形成的危险因素。

Risk factors for the formation of aberrant artery collaterals in the uterus with scar in pregnancy women underwent cesarean

Objective: To evaluate the prevalence and risk factors for the formation of aberrant artery collaterals in the uterus during uterine artery embolization (UAE). Methods: The data of 144 women with scar in the uterus due to cesarean were retrospectively analyzed. They underwent UAE in the period of 2009–2014 and were divided into two groups according to a standard with or without the aberrant artery collaterals in the uterus. The risk factors were analyzed. Results: Aberrant artery collaterals were found in thirty-four patients. According to multiple logistic regression analysis, the presence of placenta previa (RR=78.556, 95% CI: 2.869-2 150.651, P=0.010), pelvic inflammatory disease (RR=6.633, 95% CI: 1.595-27.592, P=0.009), pregnancy complications (RR=7.264, 95% CI: 1.622-32.531, P=0.010), abortions (RR=18.381, 95% CI: 1.683-200.752, P=0.017) and uterine fibroids or adenomyosis (RR=12.580, 95% CI: 1.004-157.550, P=0.050) were the factors for the presence of aberrant artery collaterals. Conclusion: Aberrant artery collaterals were more frequent in patients with pelvic inflammatory disease, pregnancy complications, abortions and uterine fibroids or adenomyosis.