子宫动脉栓塞术联合腹腔镜下病灶切除术治疗瘢痕子宫切口妊娠

Efficacy and safety of uterine artery embolization combined with laparoscopic lesion excision in the treatment of cesarean scar pregnancy

目的探讨子宫动脉栓塞术(UAE)联合腹腔镜下病灶切除术治疗瘢痕子宫切口妊娠(CSP)的疗效及安全性。方法选取2014年1月~2019年12月我院收治的80例CSP患者为研究对象,按治疗方法不同分为对照组39例和观察组41例,其中对照组采用腹腔镜下病灶切除术,观察组采用UAE+腹腔镜下病灶切除术。比较两组临床疗效、围术期指标(手术时间、术中出血量、术后阴道流血时间、住院时间)、术前、术后3个月的血流参数[血管形成指数(VI)、血流搏动指数(PI)、阻力指数(RI)、血流指数(FI)]、卵巢功能[促卵泡生长激素(FSH)、雌二醇(E2)、抗苗勒管激素(AMH)、促黄体生成素(LH)]水平变化、疾病相关指标恢复时间[血清人绒毛膜促性腺激素(β-hGG)转阴时间、宫腔肿块消失、月经复潮时间],并通过记录其术后并发症发生情况评估其治疗安全性。结果观察组手术时间、术中出血量、术后阴道流血时间、住院时间均明显低于对照组(P<0.05);术后3个月,两组VI水平均较术前显著下降(P<0.05),且观察组明显低于对照组(P<0.05),而两组PI、RI、FI水平比较均无统计学意义(P>0.05);术后3个月,两组患者FSH、E2、AMH、LH水平较术前比较均无明显差异(均P>0.05),且两组术后比较无统计学意义(P>0.05);两组患者β-hGG水平转阴时间、宫腔肿块消失、月经复潮时间比较均无统计学意义(P>0.05);两组恶心呕吐、白细胞减少、腹痛、发热、盆腔感染等术后并发症发生率比较均无统计学意义(均P>0.05)。结论UAE联合腹腔镜下病灶切除术可明显缩短手术时间、术后阴道流血时间、住院时间、减少术中出血量,有效改善CSP患者血清β-hGG水平,有利于宫腔异常包块的消失与月经周期的恢复,对卵巢功能无明显影响,且不会增加并发症发生率,具有较高的安全性。

Objective To observe the efficacy and safety of uterine artery embolization(UAE)combined with laparoscopic lesion excision in the treatment of cesarean scar pregnancy(CSP).Methods The clinical data of 80 CSP patients treated in our hospital from January 2014 to December 2019 were retrospectively analyzed,and the patients were grouped according to the treatment methods,including 39 cases in control group(laparoscopic lesion excision)and 41 cases in observation group(UAE+laparoscopic lesion excision).The clinical efficacy,perioperative indicators[operative time,intraoperative blood loss,postoperative vaginal bleeding time,hospital stay],and blood flow parameters[vascularization index(VI),blood Flow pulsation index(PI),resistance index(RI),blood flow index(FI)],ovarian function[follicle stimulating hormone(FSH),estradiol(E2),anti-müllerian hormone(AMH),luteinizing hormone(LH)]and recovery times of disease-related indicators[negative conversion time of serum human chorionic gonadotropin(β-hGG),disappearance time of abnormal uterine masses,menstruation recovery time]before surgery and at 3 months after surgery were compared between the two groups,and the occurrence of postoperative complications were used to evaluate the safety of treatment.Results The operative time,intraoperative blood loss,postoperative vaginal bleeding time,and hospital stay in observation group were significantly lower than those in control group(P<0.05).At 3 months after surgery,the VI levels of the two groups were significantly lower than those before surgery(P<0.05),and the level in observation group was significantly lower than that in control group(P<0.05),and there were no statistically significant differences in the PI,RI,and FI levels between the two groups(P>0.05).At 3 months after surgery,there were no significant differences in the levels of FSH,E2,AMH,and LH in the two groups compared with those before surgery(P>0.05),and there were no statistically significant differences between the two groups after surgery(P>0.05).There were no statistically significant differences in the negative conversion time ofβ-hGG,disappearance time of abnormal uterine masses andmenstruationrecovery time between the two groups(P>0.05).There were no statistically significant differences in the incidence rates of postoperative complications such as nausea and vomiting,leukopenia,abdominal pain,fever,and pelvic infection between the two groups(all P>0.05).Conclusion UAE combined with laparoscopic lesion excision and laparoscopic surgery can effectively improve the serumβ-hGG level in patients with CSP,and are beneficial to the disappearance of abnormal uterine masses and the recovery of menstrual cycles,and have no significant effect on ovarian function.And the two are similar in terms of complications,but the combination of UAE can significantly reduce the operative time,intraoperative blood loss,postoperative vaginal bleeding time,and hospital stay.