子宫动脉栓塞术对胎盘前置状态引产患者生育能力及再妊娠结局的影响研究

Effects of uterine artery embolization on fertility and re-pregnancy outcomes of induced labor patients with placenta previa

目的 探究子宫动脉栓塞术对胎盘前置状态引产患者生育能力及再妊娠结局的影响。方法 回顾性分析2012年1月至2019年12月甘肃省妇幼保健院收治的260例胎盘前置状态引产患者为研究对象,对照组患者(n=130)使用乳酸依沙吖啶+米非司酮引产,观察组患者(n=130)使用子宫动脉栓塞术联合乳酸依沙吖啶+米非司酮引产。比较两组患者引产情况、术后并发症的差异,探究两组患者术后生育能力[卵泡刺激素(FSH)、雌二醇(E2)、黄体生成激素(LH)]及两组患者再妊娠结局的差异。结果 观察组患者引产成功率、分娩率高于对照组,观察组患者总产程、失血量、住院时间、月经复潮时间均低于对照组(P <0.05);两组患者术后并发症发生率、受孕率、人工流产率、自然流产率差异均无统计学意义(P>0.05);术后4个月时,两组患者FSH、LH水平与术后2个月时相比均上升,E2则下降,且观察组患者FSH、LH水平低于对照组,E2水平高于对照组(P <0.05)。结论 胎盘前置状态患者应用子宫动脉栓塞术联合乳酸依沙吖啶+米非司酮引产安全性较好,可有效地降低对生育能力的影响,有利于改善再妊娠结局。

Objective To explore the effects of uterine artery embolization on fertility and re-pregnancy outcomes of induced labor patients with placenta previa. Methods A retrospective analysis of 260 patients with placenta previa induced labor was used as the research object. The control group(n = 130) was induced labor with ethacridine lactate + mifepristone, and the observation group(n = 130) was treated with uterine artery embolization combined with Lactated ethacridine + mifepristone to induce labor. The differences in induction of labor and postoperative complications between the two groups were compared, and the differences in postoperative fertility [follicle-stimulating hormone(FSH), estradiol(E2), and luteinizing hormone(LH)] between the two groups were investigated. Differences in pregnancy outcomes were analyzed in the two groups. Results Success rate of labor induction and delivery rate in observation group were higher than those in control group. The total stage of labor, blood loss, hospital stay and menstrual recovery time were less than those in control group(P < 0.05). There were no significant differences in incidence rates of postoperative complications, pregnancy rate, induced abortion rate and spontaneous abortion rate between the two groups(P > 0.05). 4 months after surgery, the levels of FSH and LH in the two groups were increased while level of E2 was decreased compared to those 2 months after surgery, and levels of FSH and LH were lower while E2 level was higher in observation group compared to control group(P < 0.05). Conclusion The use of uterine artery embolization combined with lactate ethacridine + mifepristone to induce labor in patients with placenta previa is safe, can effectively reduce the impact on fertility, and is conducive to improving the outcome of re-pregnancy.