Huang Jun-Rong, Sun Li-Ya, Tang Ying, Wen Ming-Bo, Yang Ming-Tao, Xu Fan, Shi Qiuling, Hu Hui-Quan
Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China.
State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.
Int J Hyperthermia. 2025 Dec;42(1):2468757. doi: 10.1080/02656736.2025.2468757. Epub 2025 Feb 25.
To investigate the significance of the cesarean section diverticulum (CSD) area for predicting the intraoperative massive hemorrhage during suction curettage for cesarean scar pregnancy (CSP) after focused ultrasound ablation surgery (FUAS).
Data from 90 patients undergoing suction curettage after FUAS were collected. According to their intraoperative bleeding volume, patients were categorized into three groups: Group 1 ( = 71, <200 mL), Group 2 ( = 9, 200-300 mL) and Group 3 ( = 10, ≥300 mL). Multiple liner regression analysis was performed to identify the influencing factors for CSD area and intraoperative blood loss. The ROC curve was plotted to identify the optimal cutoff values.
The median CSD area size in Group 3 (336.8 mm) was significantly greater than in Groups 1 (128.6 mm) and 2 (121.6 mm) ( < .05). Using multiple linear regression analysis, CSD area was associated with intraoperative blood loss ( < .05). The optimal cutoff CSD areas for predicting intraoperative massive hemorrhage volumes ≥ 200 mL and ≥ 300 mL were 202.05 mm and 241.90 mm, respectively. The mean gestational sac diameter and preoperative symptoms (+) were positively related to CSD area, while residual myometrial thickness was negatively correlated with the CSD area. CSD area showed the greatest relationship to sonication time (r = 0.42), treatment time (r = 0.316) and total energy used for ablation (r = 0.415).
The preoperative CSD area could predict intraoperative massive hemorrhage during suction curettage after FUAS, which might inform therapy strategies for CSP patients.
探讨聚焦超声消融手术（FUAS）后剖宫产瘢痕妊娠（CSP）行清宫术时，剖宫产憩室（CSD）面积对预测术中大出血的意义。
收集90例行FUAS后清宫术患者的数据。根据术中出血量，将患者分为三组：第1组（n = 71，<200 mL）、第2组（n = 9，200 - 300 mL）和第3组（n = 10，≥300 mL）。进行多元线性回归分析以确定CSD面积和术中失血量的影响因素。绘制ROC曲线以确定最佳截断值。
第3组的CSD面积中位数大小（336.8 mm）显著大于第1组（128.6 mm）和第2组（121.6 mm）（P <.05）。采用多元线性回归分析，CSD面积与术中失血量相关（P <.05）。预测术中大出血量≥200 mL和≥300 mL的最佳截断CSD面积分别为202.05 mm和241.90 mm。平均孕囊直径和术前症状（+）与CSD面积呈正相关，而残留肌层厚度与CSD面积呈负相关。CSD面积与超声时间（r = 0.42）、治疗时间（r = 0.316）和消融总能量（r = 0.415）的关系最为密切。
术前CSD面积可预测FUAS后清宫术时的术中大出血，这可能为CSP患者的治疗策略提供参考。
