早期妊娠不同终止方式对卵巢、输卵管、子宫内膜及再次受孕影响

The influence of different mode of termination of early pregnancy of women on their ovary,fallopian tube,endometrium,and the next pregnancy

目的:探讨终止早期妊娠不同流产方式对卵巢、输卵管、子宫内膜及再次妊娠结局影响。方法:选取2016年1月-2018年1月在本院终止早期妊娠200例,根据流产方式不同分为药物流产组和手术流产组,观察并比较两组卵巢功能、输卵管功能、子宫内膜厚度及再次受孕后临床结局。利用logistic回归分析自然流产的相关因素。结果:手术组术中出血量、月经复潮时间及并发症均高于药物组(P<0.05);输卵管阻塞发生率低于药物组,子宫内膜厚度在流产后2周、月经复潮后1周、术后3个月、术后6个月均低于药物组,黄体生成素(LH)、雌二醇(E2)、卵泡刺激素(FSH)、窦卵泡数术后1个月低于药物组(均P<0.05),术后6个月两组无差异(P>0.05);优质胚胎比例、不孕例数高于药物组,而自然流产率、未正常妊娠率低于药物流产组(P<0.05)。两组新生儿体重、Apgar评分比较无差异(P>0.05)。回归分析显示LH、E2、FSH、窦卵泡数、流产方式是自然流产的相关影响因素,Pearson相关性分析表明与不孕具有相关性(均P<0.05)。结论:手术流产更易造成再次妊娠自然流产及不孕,而药物流产术后恢复过程较快,但输卵管堵塞发生率相对较高,临床在不同流产方式选择时应加以避免。

Objective:To study the influence of different mode of termination of early pregnancy of women on their ovary,fallopian tube,endometrium,and the next pregnancy.Methods:200 women who wanted to terminate their early pregnancy were included in this study and were divided in group A(women experienced medical abortion)and in group B(women experienced surgical abortion)from January 2016 to January 2018.The ovarian function,fallopian tube function,endometrial thickness,and clinical outcomes of next pregnancy of women were compared between the two groups.Logistic regression was used to analyze the related factors of spontaneous abortion.Results:The amount of bleeding and menarche recovery time of women in group B were significant more than those of women in group A(P<0.05).The incidence of fallopian tube obstruction of women in group B was significant lower than that of women in group A,the endometrial thickness of women in group B in 2 weeks,3 month or 6 month after abortion,or 1 week after menstruating was significant lower than that of women in group A.The levels of LH,E2 and FSH,and antral follicle count of women in group B in 1 month after abortion were significant less than those of women in group A(P<0.05).The levels of LH,E2 and FSH,and antral follicle count(AFC)of women in group B in 6 month after abortion had no significant different from those of women in group A(P>0.05).The proportion of high-quality embryos and number of infertility of women in group B were significant higher than those of women in group A,and the rates of spontaneous abortion and abnormal pregnancy of women in group B were significant lower than those of women in group A(P<0.05).There were no significant different in neonatal weight and Apgar score between the two groups(P>0.05).Logistic regression showed that the levels of LH,E2 and FSH,AFC,and mode of abortion were the correlated effect factors,which were significantly correlated with infertile patients by Pearson correlation analysis(P<0.05).Conclusion:Surgical abortion could more likely to cause spontaneous abortion and infertility.After medical abortion,the recovery time is shorter compared to that after surgical abortion,but the incidence of relative fallopian tube blockage is higher,so different abortion mode should be chosen in clinical practice.