【摘要】 目的 探讨早孕期孕囊与膀胱间残余肌层厚度(RMT)预测剖宫产瘢痕妊娠(CSP)期待治疗妊娠结局的临床价值。方法 回顾性分析2017年1月至2021年10月间在长沙市妇幼保健院及湖南省妇幼保健院于早孕期超声诊断为CSP后，继续妊娠且经期待治疗的23例孕妇的超声图像和临床资料。在超声工作站中选取患者孕周≤10周的子宫矢状面图像，显示子宫残余肌层，测量剖宫产切口部位的RMT,每例测量3次，取平均值；根据测量值将患者分为RMT≤3mm组(12例)与RMT>3mm组(11例),比较两组患者剖宫产不同术中出血量和不同胎盘病理性附着(MAP,胎盘植入)类型的发生率，分析早孕期RMT与CSP孕妇剖宫产术中出血量、胎盘植入程度的相关性。结果 RMT≤3mm组患者术中出血量≥500mL的发生率高于RMT>3mm组，两组比较差异有统计学意义(75.0%vs.27.3%,Fisher确切概率法P=0.039);RMT≤3mm组MAP严重类型(植入型或穿透型胎盘)的发生率高于RMT>3mm组，两组比较差异有统计学意义(83.3%vs.27.3%,Fisher确切概率法P=0.012)。Spearman相关性分析显示，RMT与术中出血量呈负相关(r=-0.486,P=0.019),RMT与胎盘植入程度呈负相关(r=-0.601,P=0.002)。RMT预测术中出血量<500mL的最佳切值为3.3mm,曲线下面积为0.746,P=0.045,灵敏度为72.7%,特异度为75.0%;RMT预测非严重类型MAP的最佳切值为3.3mm,曲线下面积为0.781,P=0.024,灵敏度为80.0%,特异度为76.9%。结论 早孕期RMT与CSP患者剖宫产术中出血量、胎盘植入类型均有相关性，早孕期测量RMT有助于临床筛选出适合期待治疗的CSP患者。更多还原

【Abstract】 Objective To determine whether residual myometrial thickness(RMT) between the bladder and gestational sac in early pregnancy can be used to predict clinical outcome of women with cesarean scar pregnancy(CSP) after expectant(symptomatic) management.Methods The clinical data and early ultrasound images of 23 patients who were diagnozed as CSP during early pregnancy and were willing to continue the pregnancy and received expectant management in The Affiliated Changsha Maternal and Child Health Hospital of Hunan Normal University and Hunan Provincial Maternal and Child Health Hospital from January 2017 to October 2021 were retrospectively analyzed.The sagittal section images of the uterus of the patients with gestational age ≤10 weeks were selected from ultrasound workstation to show residual myometrium, and RMT at incision site of cesarean section was measured.Each patient received 3 times of measurement, and the average value was taken.The patients were divided into RMT≤3mm group(12 cases) and RMT>3mm group(11 cases) according to the RMT value measured.The intraoperative blood loss and the incidence of different types of morbidly adherent placenta(MAP) were compared between the two groups.The correlation of RMT with amount of intraoperative blood loss and type of MAP(placenta implantation) was analyzed.Results The incidence of intraoperative blood loss ≥500mL in the RMT≤3mm group was significantly higher than that in the RMT>3mm group(75.0% vs. 27.3%,Fisher’s exact probability method: P=0.039).The incidence of severe types of MAP(placenta increta or placenta percreta) in the RMT≤3mm group was significantly higher than that in the RMT>3mm group, and the difference was statistically significant(83.3% vs. 27.3%,Fisher’s exact probability method: P=0.012).Spearman’s correlation analysis showed that RMT was negatively correlated with amount of intraoperative blood loss(r=-0.486),and it was also negatively correlated with degree of placental implantation in CSP patients(r=-0.601).The best cut-off value of RMT for predicting intraoperative blood loss <500mL was 3.3mm, the area under the curve(AUC) was 0.746,the sensitivity was 72.7%,and the specificity was 75.0%.The best cut-off value of RMT for predicting non-severe MAP was 3.3mm, the AUC was 0.781,the sensitivity was 80.0%,and the specificity was 76.9%.Conclusion RMT in early pregnancy is correlated with amount of intraoperative blood loss in later cesarean section and type of placenta implantation in CSP patients, which is helpful for clinical screening of CSP patients who are suitable for expectant management.更多还原