摘要
目的探讨MRI预测剖宫产切口瘢痕妊娠(CSP)术中大出血风险的价值。方法回顾性分析2018年1月至12月北京大学第三医院经手术及病理证实的77例CSP患者资料,均在术前行MRI平扫检查,按其终止妊娠术中出血量分为术中大出血组11例和非术中大出血组66例。记录患者的临床资料,包括年龄、停经时间、剖宫产次数、距末次剖宫产时间、人工流产次数、术前人绒毛膜促性腺激素(β-hCG)值,并记录术前MRI影像特征(CSP分型、孕囊的最大直径、子宫下段瘢痕厚度及孕囊周围或宫腔出血)。采用独立样本t检验或配对秩和检验比较两组间计量资料的差异,采用χ²检验比较计数资料的差异。将两组间差异有统计学意义的危险因素进行多因素logistic回归分析。绘制受试者操作特征曲线,评估预测术中大出血的效能。结果停经时间、孕囊最大直径、子宫下段瘢痕厚度在CSP术中大出血组和非术中大出血组间差异具有统计学意义(P<0.05)。年龄、剖宫产次数、距末次剖宫产时间、人工流产次数、术前β-hCG值、CSP类型、孕囊周围或宫腔出血在两组间差异无统计学意义(P>0.05)。多因素logistic回归分析显示,两组间仅子宫下段瘢痕厚度差异有统计学意义(P=0.002,比值比为4.222,95%可信区间为1.679~10.614)。停经时间、孕囊最大直径、子宫下段瘢痕厚度的预测术中大出血的曲线下面积分别为0.750、0.829和0.899,最佳预测指标为子宫下段瘢痕厚度,其预测的最佳阈值为2.25 mm,诊断灵敏度、特异度、约登指数分别为90.9%、75.8%和66.7%。结论子宫下段瘢痕厚度是CSP术中出血的独立危险因素,术前MRI仔细观察子宫下段瘢痕形态,客观、准确地测量其厚度,可较准确预测术中大出血风险。
Objective To investigate the application value of magnetic resonance imaging(MRI)in predicting intraoperative massive hemorrhage for cesarean scar pregnancy(CSP).Methods From January to December 2018,77 CSP patients confirmed by operation and pathology in Peking University Third Hospital were retrospectively enrolled in this study.All patients underwent MR scans in three days before operation.According to the amount of intraoperative blood loss,CSP patients were divided into intraoperative massive hemorrhage group(n=11)and non-massive hemorrhage group(n=66).Clinical data including patients age,the gestational age,number of cesarean delivery,interval between current CSP and last cesarean,number of abortions and preoperative human chorionic gonadotropin(β-hCG)were recorded.MRI features including CSP types,the maximum diameter of the gestational sac,the lower uterus scar thickness and gestational sac,as well as uterine hemorrhage were reviewed.The reliability of the maximum diameter of the gestational sac,and the lower uterus scar thickness measurements were evaluated by inter-class correlation coefficient(ICC).Univariate analysis was used to compare the differences of clinical data and MRI features between the two groups.Factors with significant statistical differences were further analyzed by multivariate logistic regression.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy and optimal threshold of predicting CSP intraoperative massive hemorrhage.Results The gestational age,the maximum diameter of the gestational sac,and the lower uterus scar thickness were significantly different between two groups(P<0.05).There was no significant difference in age,number of cesarean delivery,interval between current CSP and last cesarean,number of abortions,preoperativeβ-hCG,CSP types,gestational sac,or uterine hemorrhage between two groups(P>0.05).Multivariate logistic regression analysis showed that only the lower uterus scar thickness was significantly different(P=0.002,odds ratio=4.222,95%confidence interval=1.679 to 10.614)between two groups.The ROC curve analysis showed that the area under curve of the gestational age,the maximum diameter of the gestational sac,and the lower uterus scar thickness were 0.750,0.829 and 0.899,respectively.The best predictor was the lower uterus scar thickness,with the optimal cutoff value as 2.25 mm,and the diagnostic sensitivity,specificity,and the Youden index as 90.9%,75.8%,66.7%,respectively.Conclusion The lower uterus scar thickness can be used as an independent risk factor for CSP intraoperative massive hemorrhage.Preoperative MRI,with accurately assessing morphology of the lower uterus scar and measuring the thickness,may predict the risk of intraoperative massive hemorrhage in CSP patients.
作者
曾飘娥
王丰
周延
张立华
何为
刘剑羽
Zeng Piao'e;Wang Feng;Zhou Yan;Zhang Lihua;He Wei;Liu Jianyu(Department of Radiology,Peking University Third Hospital,Beijing 100191,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2020年第10期964-968,共5页
Chinese Journal of Radiology
关键词
磁共振成像
剖宫产切口瘢痕妊娠
术中大出血
Magnetic resonance imaging
Cesarean scar pregnancy
Intraoperative massive hemorrhage
作者简介
通信作者:刘剑羽,Email:ljybysy@163.com.
