预防性子宫动脉栓塞在瘢痕妊娠清宫术前的应用效果观察

Application effect observation of prophylactic uterine artery embolization in scar pregnancy before curettage

目的探究预防性子宫动脉栓塞在瘢痕妊娠清宫术前的应用效果。方法2016年1月至2019年1月我院收治的122例瘢痕妊娠患者,其中45例给予局部药物治疗后行刮宫术(药物组),77例子宫动脉栓塞后行刮宫术(栓塞组)。记录两组患者刮宫前准备时间、刮宫过程中出血量、住院时间、住院费用、术后月经恢复时间、并发症发生情况,术前及术后1个月后测定卵泡刺激素(FSH)、黄体生成素(LH)及雌二醇(E2)水平。结果栓塞组患者刮宫前准备时间、术后出血量、术后人绒毛膜促性腺激素(β-HCG)水平恢复正常时间及住院时间显著低于药物组(P<0.05);两组患者治疗前后FSH、E2、LH水平比较差异均无统计学意义(P>0.05);栓塞组术后疼痛发生率高于药物组,清宫术中大出血及清宫不全发生率显著低于药物组(P<0.05);两组患者术后再次正常妊娠率及月经规律率比较差异无统计学意义(P>0.05)。结论将预防性子宫动脉栓塞应用于瘢痕妊娠刮宫术前,可降低术前准备时间、术中出血量、住院时间,降低术中大出血、清宫不全等严重并发症发生率,提高手术效果,具有一定的临床意义。

Objective To explore the application effects of prophylactic uterine artery embolization(UAE)on scar pregnancy before curettage.Methods One hundred and twenty-two patients undergoing scar pregnancy were divided into drug group(n=45)and embolization group(n=77)according to treatment methods.The drug group was given local drug therapy and then curettage.The embolization group was given UAE and then curettage.The preparation time before curettage,blood loss in curettage process,hospitalization time,hospitalization expenses,postoperative menstrual recovery time and occurrence of complications were recorded.Before and after 1 month of surgery,level of follicle stimulating hormone(FSH),luteinizing hormone(LH)and estradiol(E2)were measured.Results The preparation time before curettage,postoperative blood loss,time of human chorionic gonadotropin(β-HCG)level returning to normal and hospitalization time in the embolization group were significantly shorter or lower than those in the drug group(P<0.05).There was no significant difference in FSH,E2 or LH level before and after treatment between the two groups(P>0.05).The incidence of postoperative pain in the embolization group was higher than that in the drug group(P<0.05),while incidence of hemorrhage in curettage process and curettage incompleteness was significantly lower than that in the drug group(P<0.05).There was no significant difference in the rates of normal pregnancy and menstrual regularity in the long-term follow-up between the two groups(P>0.05).Conclusion Application of prophylactic UAE in scar pregnancy before curettage can reduce the preoperative preparation time,intraoperative blood loss,hospitalization time,incidence of serious complications such as intraoperative hemorrhage and curettage incompleteness,and improve the surgical effect.It is of certain clinical significance.