UACE序贯超声引导清宫术治疗瘢痕妊娠疗效观察

Clinical observation of uterine artery chemoembolization together with sequential ultrasound-guided uterine curettage for scar pregnancy

目的探究子宫动脉化疗栓塞术(UACE)序贯超声引导清宫术治疗子宫瘢痕妊娠(CSP)的临床疗效。方法将2015年8月至2019年2月在渭南市第一医院治疗的80例剖宫产术后CSP患者纳入研究,按照入院编号尾数的奇偶,将患者均分为观察组和对照组各40例。对照组患者行单纯超声引导清宫术,观察组患者则采用UACE序贯超声引导清宫术治疗。比较两组患者的术中出血量、住院时间、血清人绒毛膜促性腺激素(β-HCG)转阴时间以及月经恢复时间。对比两组患者在手术前后的卵泡刺激素(FSH)、黄体生成激素(LH)、抗苗勒氏管激素(AMH)、雌二醇(E2)、抑制素B(INHB)水平,同时比较两组患者的并发症发生情况。结果观察组患者的术中出血量、住院时间、血清β-HCG转阴时间以及月经恢复时间分别为(13.25±2.36)mL、(6.94±1.17)d、(18.73±4.46)d、(41.38±7.45)d,均明显低于对照组的(36.18±6.44)mL、(9.62±2.16)d、(23.86±5.18)d、(47.03±8.16)d,差异均有统计学意义(P<0.05);无论是两组患者术前、术后1个月的FSH、LH、AMH、E2和INHB水平比较,还是两组患者术后1个月的FSH、LH、AMH、E2和INHB水平与其术前比较,差异均无统计学意义(P>0.05);观察组患者的并发症发生率为7.50%,明显低于对照组的27.50%,差异有统计学意义(P<0.05)。结论UACE序贯超声引导清宫术能够有效降低瘢痕妊娠组织活性及切口处血供,有助于减少术中出血量,且对患者的卵巢功能无显著影响,能够较好地保留患者的生育功能。

Objective To research clinical efficacy of uterine artery chemoembolization(UACE)together with sequential ultrasound-guided uterine curettage in the treatment of pregnancy with scar pregnancy.Methods Eighty patients of cervical scar pregnancy(CSP)after cesarean section in the First Hospital of Weinan City from August 2015 to February 2019 were selected as the study subjects.They were divided into observation group and control group according to the odd and even number of admission.The patients in the control group were treated with simple ultrasound-guided uterine curettage,while those in the observation group were treated with UACE with sequential ultrasound-guided uterine curettage.The intraoperative bleeding volume,length of hospital stay,time of serum human chorionic gonadotropin(β-HCG)turning negative and menstrual recovery time of the two groups were compared,and the levels of follicle stimulating hormone(FSH),luteinizing hormone(LH),anti-Mullerian hormone(AMH),estradiol(E2)and inhibin B(INHB)of the two groups were compared before and after operation.The complications of the two groups were statistically analyzed.Results The bleeding volume,length of hospital stay,time of serumβ-HCG turning negative and menstrual recovery time in the observation group were(13.25±2.36)mL,(6.94±1.17)d,(18.73±4.46)d,(41.38±7.45)d,respectively,significantly lower than(36.18±6.44)mL,(9.62±2.16)d,(23.86±5.18)d,(47.03±8.16)d in the control group(P<0.05).The levels of FSH,LH,AMH,E2,and INHB in the observation group before and 1 month after operation were not significantly different from those in the control group(P>0.05).There was no significant difference in FSH,LH,AMH,E2,and INHB levels between the two groups at 1 month after operation(P>0.05).The incidence of complications in the observation group was 7.50%,which was significantly lower than 27.50%in the control group(P<0.05).Conclusion UACE with sequential ultrasound-guided uterine curettage can effectively reduce the activity of scar pregnancy tissue and blood supply at the incision,help to reduce intraoperative bleeding,and has no significant effect on ovarian function.It can keep the reproductive function of patients well.