| 周春桥,黎新艳,莫宇宁,韦芳桃,黄艳凤,谢海容.超声参数预测剖宫产瘢痕妊娠患者可否获益于单一超声引导下清宫术[J].中国医学影像技术,2024,40(9):1377~1381 |
| 超声参数预测剖宫产瘢痕妊娠患者可否获益于单一超声引导下清宫术 |
| Ultrasonic parameters for predicting cesarean scar pregnancy patients benefit from transabdominal ultrasound-guided suction curettage alone |
| 投稿时间：2023-12-24 修订日期：2024-06-13 |
| DOI：10.13929/j.issn.1003-3289.2024.09.021 |
| 中文关键词: 剖宫产术 妊娠,异位 超声检查 刮宫术 前瞻性研究 |
| 英文关键词:cesarean section pregnancy, ectopic ultrasonography dilatation and curettage prospective studies |
| 基金项目:广西科技计划项目重点研发计划(桂科AB23026011)。 |
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| 中文摘要: |
| 目的 观察超声预测剖宫产瘢痕妊娠(CSP)患者可否获益于单一超声引导下清宫术的价值。方法 前瞻性招募140例经阴道超声诊断CSP并首次接受单一超声引导下清宫术患者,根据清宫术中出血及术后转归将其分为获益组(n=103)与未获益组(n=37);记录患者基本资料及CSP病灶声像图特征,测量瘢痕处绒毛厚度、子宫前壁下段残余肌层厚度及孕囊最大径并进行组间比较;针对组间差异有统计学意义的计量资料绘制受试者工作特征(ROC)曲线,获取最佳截断值,并将其转换为分类预测变量。利用多因素logistic回归筛选声像图特征及分类预测变量中的独立预测因素,以之联合建立预测模型;根据曲线下面积(AUC)评估分类预测变量单一及其联合预测模型的预测效能并加以比较。结果 相比未获益组,获益组孕周较小(P＜0.05),且超声表现为富血供、有胚芽及有心管搏动者占比较低,瘢痕处绒毛较薄、残余肌层较厚而孕囊最大径较小(P均＜0.05)。ROC曲线显示,瘢痕处绒毛厚度二分类最佳截断值为4.7 mm,残余肌层厚度最佳截断值为1.8 mm,孕囊最大径最佳截断值为29 mm,将其转换为分类预测变量;多因素logistic回归分析显示,转换后的分类预测变量,包括瘢痕处绒毛厚薄、残余肌层厚薄及孕囊大小均为CSP患者可否获益于超声引导下清宫术的独立预测因素(P均＜0.05);三者联合构建的预测模型的AUC为0.918,均高于各单一因素(P均＜0.05)。结论 瘢痕处绒毛厚度≤4.7 mm、残余肌层厚度＞1.8 mm及孕囊最大径≤29 mm是CSP患者获益于超声引导下清宫术的独立预测因素;三者联合的logistic回归模型的预测效能高于各单一因素。 |
| 英文摘要: |
| Objective To observe the value of ultrasonic parameters for predicting whether patients with cesarean scar pregnancy (CSP) would benefit from ultrasound-guided suction curettage alone. Methods Totally 140 CSP patients diagnosed by transvaginal ultrasound and initially treated with ultrasound-guided suction curettage alone were prospectively recruited and categorized into benefited group (n=103) and non-benefited group (n=37) according to bleeding during suction curettage and prognoses. The ultrasonic manifestations of CSP were observed, and the thickness of chorionic villi at the scar, as well as of residual myometrium of the anterior wall in the lower segment of the uterus, also the maximum diameter of the gestational sac were measured and compared between groups, and the parameters with quantitative data being statistically different between groups were converted into categorical predictor through analyzing of the receiver operating characteristic (ROC) curves and the optimal cut-off values. The independent predictors were selected among ultrasonic features and categorical predictor variables being statistically different between groups using multivariate logistic regression, and a combined predicting model was then constructed, and the predicting efficacy of the combined model and each categorical predictor alone was assessed according to the area under curve (AUC) and then were compared. Results Compared with non-benefited group, the gestational weeks in benefited group were smaller (P＜0.05), and the percentages of rich blood supply and the presence of embryos and fetal heartbeats were lower, with thinner chorionic villi at the scar, thicker residual myometrium and smaller maximal diameter of the gestational sac in benefited group (all P＜0.05). ROC curves analyses yielded the best cut-off value for dichotomy of chorionic villi thickness at the scar was 4.7 mm, of residual myometrium thickness was 1.8 mm and of the maximum diameter of the gestational sac was 29 mm, respectively, and then categorical predictor variable were obtained. Multivariate logistic regression showed that the transformed categorical predictors, i.e. the thickness degree of the chorionic villi at the scar, the thickness degree of the residual muscle layer and the size degree of the gestational sac, were all independent predictors of whether CSP patients would benefit from ultrasound-guided suction curettage alone (all P＜0.05). The AUC of the combined predicting model was 0.918, higher than that of each transformed categorical predictor alone (all P＜0.05). Conclusion The thickness of the chorionic villi at the scar ≤4.7 mm, the thickness of the residual muscle layer ＞1.8 mm and the maximum diameter of the gestational sac ≤29 mm were all independent predictors of CSP patients would benefit from ultrasound-guided suction curettage alone, and the predicting efficacy of the combined model was higher than that of each alone. |
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