甲氨蝶呤动脉灌注及子宫动脉栓塞联合清宫术对Ⅰ型剖宫产术后剖宫产瘢痕部位妊娠患者子宫动脉血流动力学、卵巢功能及血清SCC-Ag、SFlt-1和Ki-67的影响

Effects of Curettage Combined with Arterial Perfusion of Methotrexate and Uterine Artery Embolization on the Hemodynamics,Ovarian Function and Serum SCC-Ag,sFlt-1 and Ki-67 in Patients with Cesarean Scar Pregnancy After TypeⅠCesarean Section

目的:探讨甲氨蝶呤动脉灌注及子宫动脉栓塞联合清宫术对Ⅰ型剖宫产术后剖宫产瘢痕部位妊娠(cesarean scar pregnancy,CSP)患者子宫动脉血流动力学、卵巢功能及血清鳞状细胞癌抗原(SCC-Ag)、可溶性血管内皮生长因子受体1(sFlt-1)和细胞增殖抗原-67(Ki-67)的影响。方法:将2016年9月至2019年1月于喀什地区第二人民医院接受治疗的70例Ⅰ型剖宫产术后CSP患者纳为研究对象,根据治疗方式的差异,将患者分为观察组(甲氨蝶呤动脉灌注+子宫动脉栓塞+清宫术,n=35)与对照组(开腹手术+常规治疗,n=35)。观察两组患者术后恢复情况,治疗前后血流动力学指标、卵巢内分泌功能及血清SCC-Ag、SFlt-1和Ki-67水平变化情况。结果:观察组患者术中出血量明显少于对照组,月经恢复时间明显短于对照组,β-人绒毛膜促性腺激素水平恢复时间明显短于对照组,差异均有统计学意义(P<0.05)。治疗后,观察组患者各血流动力学指标(血流搏动指数、阻力指数)水平、卵巢各激素(黄体生成素、卵泡刺激素和雌激素)分泌水平明显高于对照组,血清SCC-Ag、SFlt-1和Ki-67水平明显低于对照组,差异均有统计学意义(P<0.05)。观察组患者的并发症发生率为8.57%(3/35),明显低于对照组的28.57%(10/35),差异有统计学意义(χ^2=4.629,P=0.031)。结论:甲氨蝶呤动脉灌注及子宫动脉栓塞联合清宫术治疗Ⅰ型剖宫产术后CSP的疗效显著,可以有效提高患者的临床疗效,促进患者病情康复,降低不良反应发生率。

OBJECTIVE:To probe into the effects of curettage combined with arterial perfusion of methotrexate and uterine artery embolization on the hemodynamics,ovarian function and serum squamous-cell carcinoma antigen(SCC-Ag),soluble vascular endothelial growth factor 1(sFlt-1)and cell proliferation antigen-67(Ki-67)in patients with cesarean scar pregnancy(CSP)after typeⅠcesarean section.METHODS:Totally 70 patients with CSP after typeⅠcesarean section admitted into the Kashgar Prefecture Second People’s Hospital from Sept.2016 to Jan.2019 were selected and divided into observation group(treated with arterial perfusion of methotrexate+uterine artery embolization+curettage,35 cases)and control group(laparotomy+conventional therapy,35 cases)according to different therapeutic regimens.The postoperative recovery,changes of hemodynamic indicators,ovarian endocrine function and serum SCCAg,SFlt-1 and Ki-67 of the two groups before and after treatment were observed.RESULTS:The intraoperative blood loss of observation group was significantly less than that of the control group,the recovery time of menstruation andβ-human chorionic gonadotropin of observation group were significantly shorter than those of the control group,with statistically significant differences(P<0.05).After treatment,the hemodynamic indicators(PI and RI)and various ovarian hormone(LH,FSH and E2)secretion levels of observation group were significantly higher than those of the control group,while the serum SCC-Ag,sFlt-1 and Ki-67 levels were significantly lower than those of the control group,with statistically significant differences(P<0.05).The incidence of complications of observation group was 8.57%(3/35),which was significantly lower than that of the control group(28.57%,10/35),with statistically significant differences(χ^2=4.629,P=0.031).CONCLUSIONS:The efficacy of curettage combined with arterial perfusion of methotrexate and uterine artery embolization in the treatment of CSP after typeⅠcesarean section is remarkable,which can significantly improve the clinical efficacy,promote patients’recovery and reduce the incidence of adverse drug reactions.