Chiang Ying-Cheng, Tu Yi-An, Yang Jehn-Hsiahn, Lin Shin-Yu, Lee Chien-Nan, Shih Jin-Chung
Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Int J Gynaecol Obstet. 2017 Jul;138(1):28-36. doi: 10.1002/ijgo.12157. Epub 2017 Apr 5.
To identify risk factors associated with treatment failure among women with cesarean scar pregnancy (CSP).
In a retrospective study, the medical records of patients with CSP treated at National Taiwan University Hospital, Taipei, Taiwan, from 1994 to 2015 were reviewed. The women were managed primarily with hysterotomy, evacuation, or methotrexate. Receiver operating characteristic (ROC) curve analysis and logistic regression analysis were used to evaluate the factors associated with treatment failure.
Among 90 patients, 44 underwent hysterotomy, 18 underwent evacuation, and 28 received methotrexate. The success rates were 100% (44/44) for hysterotomy, 83% (15/18) for evacuation, and 57% (16/28) for methotrexate (P<0.001). ROC curve analysis indicated that a pregnancy length of 8 weeks and a mean sac diameter (MSD) of 4 cm were both predictive of failure of treatment by primary evacuation and methotrexate. In multivariate logistic regression analysis, an MSD of 4 cm or more was the only independent risk factor for treatment failure (odds ratio 68.99, 95% confidence interval 6.27-759.60; P=0.001).
Primary hysterotomy was suitable for treatment of CSP of any size. Failure of primary evacuation or methotrexate usually occurred when the MSD was larger than 4 cm.
确定剖宫产瘢痕妊娠（CSP）女性治疗失败的相关危险因素。
在一项回顾性研究中，回顾了1994年至2015年在台湾台北国立台湾大学医院接受治疗的CSP患者的病历。这些女性主要接受子宫切开术、清宫术或甲氨蝶呤治疗。采用受试者工作特征（ROC）曲线分析和逻辑回归分析来评估与治疗失败相关的因素。
90例患者中，44例行子宫切开术，18例行清宫术，28例接受甲氨蝶呤治疗。子宫切开术的成功率为100%（44/44），清宫术为83%（15/18），甲氨蝶呤为57%（16/28）（P<0.001）。ROC曲线分析表明，妊娠时长8周和平均孕囊直径（MSD）4 cm均提示初次清宫术和甲氨蝶呤治疗失败。多因素逻辑回归分析显示，MSD≥4 cm是治疗失败的唯一独立危险因素（比值比68.99，95%置信区间6.27 - 759.60；P = 0.001）。
初次子宫切开术适用于任何大小的CSP治疗。当MSD大于4 cm时，初次清宫术或甲氨蝶呤治疗通常会失败。
