不同直径明胶海绵行子宫动脉栓塞术联合甲氨蝶呤治疗子宫瘢痕妊娠效果及对卵巢功能影响

Comparison of the effect of uterine artery embolization by different diameter gelatin sponges combined with methotrexate for treating women with uterine scar pregnancy and their influence on their ovarian function

目的:探讨不同直径明胶海绵行子宫动脉栓塞术联合甲氨蝶呤治疗子宫瘢痕妊娠(CSP)效果及对患者卵巢功能的影响。方法:选择2018年2月-2020年5月本院收治的CSP患者100例,按照明胶海绵不同直径分为A组(直径1mm,n=35)、B组(直径500um~700um,n=32)、C组(直径1000um~1400um,n=33),均予以甲氨蝶呤联合治疗。比较3组清宫术总出血量、介入手术费用、β-hCC恢复时间。观察治疗前后血清人绒毛膜醋性腺激素(β-hCG)、雌二醇(E_(2))、促黄体生成素(LH)、卵泡刺激素(FSH)水平,分析不良反应情况。结果:清宫术总出血量、β-hCC恢复时间3组无差异(P>0.05),A组介入手术费用低于B组和C组(P<0.05)。3组β-hCG、LH水平各时点比较存在差异(P>0.05),而组间、交互比较无差异(P<0.05);3组E_(2)、FSH的时点、组间、交互比较无差异(P<0.05);治疗后2d、7d、21d,3组β-hCG均低于治疗前(P<0.05),3组E_(2)、LH、FSH水平无差异,总不良反应发生率无差异(均P>0.05),A组无腹痛发生。结论:直径1mm明胶海绵条联合甲氨蝶呤治疗CSP能取得与其他直径明胶海绵相当效果,但费用更低,安全性更高。

Objective:To investigate the effect of uterine artery embolization by different diameter gelatin sponges combined with methotrexate for treating women with uterine scar pregnancy(CSP),and to study its influence on the ovarian function of these women.Methods:100 women with CSP were selected and were treated by uterine artery embolization of gelatin sponges combined with methotrexate from February 2018 to May 2020.These women were divided into group A(35 women given uterine artery embolization with 1 mm diameter of gelatin sponge),group B(32 women given uterine artery embolization with 500 um-700 um diameter of gelatin sponge),and group C(33 women given uterine artery embolization with gelatin sponge with 1000 um-1400 um diameter of gelatin sponge)according to the different diameters of the gelatin sponge.The total blood loss,the cost of interventional surgery,and the time ofβ-HCC returned to normal of the women were compared among the three groups.The levels of serumβ-human chorionic vinegar gonadotropin(β-HCG),estradiol(E_(2)),luteinizing hormone(LH),and follicle stimulating hormone(FSH)of the women before and after treatment were observed.The adverse reactions situation of the women was analyzed.Results:There were no significant differences in total blood loss and the time ofβ-HCC returned to normal of the women among the three groups(P>0.05).The cost of surgery of the women in group A was significantly lower than that of the women in group B or group C(P<0.05).There were significant differences in the levels ofβ-HCG and LH of the women in the three groups among different time(P>0.05),but which of the women had no significant different among the three groups(P<0.05).Theβ-HCG level of the women in the three groups in 2 d,7 d,and 21 d after treatment were significantly lower than those before treatment(P<0.05).There were no significant differences in the levels of E_(2),LH,and FSH,and the incidence of total adverse reactions of the women among the three groups(all P>0.05).There was no any woman with stomachache in group A.Conclusion:1 mm diameter of gelatin sponge strip combined with methotrexate for treating women with uterine scar pregnancy can achieve the same effect as other diameter of gelatin sponges with lower cost and higher safety.