甲氨蝶呤及子宫动脉栓塞联合清宫术治疗剖宫产后子宫切口妊娠患者的临床效果及对激素水平的影响

Clinical Effect of Methotrexate and Uterine Artery Embolization Combined with Curettage on Patients with Cesarean Scar Pregnancy after Cesarean Section and Its Influences on Hormones

目的:研究甲氨蝶呤(MTX)及子宫动脉栓塞联合清宫术治疗剖宫产后子宫切口妊娠(CSP)患者的效果,并探讨对激素水平的影响。方法:选择2018年9月-2021年9月于北京航天总医院就诊的86例CSP患者,根据治疗方式不同将患者分为对照组(40例)和观察组(46例)。对照组于清宫术前进行子宫动脉栓塞治疗,观察组在对照组的基础上加用MTX。比较两组手术情况、子宫动脉血流动力学指标[血流搏动指数(PI)、阻力指数(RI)]、性激素[黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E_(2))]、术后血清人绒毛膜促性腺激素(β-hCG)水平、并发症发生情况及预后。结果:两组清宫手术时间比较,差异无统计学意义(P>0.05)。观察组术中出血量少于对照组,住院时长短于对照组,差异均有统计学意义(P<0.05)。两组不良事件发生率比较,差异无统计学意义(P>0.05)。术后1个月,两组子宫动脉PI、RI比较,差异均无统计学意义(P>0.05)。术后1个月,两组LH、FSH水平比较,差异均无统计学意义(P>0.05)。术后1个月,观察组术后E_(2)水平高于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。术后1、3、7 d,两组β-hCG水平均低于术前,观察组均低于对照组,差异均有统计学意义(P<0.05)。观察组β-hCG转阴时间、阴道出血持续时间及术后月经恢复时间均短于对照组,差异均有统计学意义(P<0.05)。结论:MTX及子宫动脉栓塞联合清宫术有助于减少CSP患者术中出血量和术后并发症发生率,缩短住院时间,且有利于术后性激素分泌及月经周期的快速恢复。

Objective:To explore the effect of Methotrexate(MTX)and uterine artery embolization combined with curettage on patients with cesarean scar pregnancy(CSP)after cesarean section and its influences on hormones.Method:A total of 86 patients with CSP treated in Beijing Aerospace General Hospital from September 2018 to September 2021 were selected,according to different treatment methods,they were divided into control group(40 cases)and observation group(46 cases).Before curettage,control group was treated with uterine artery embolization,while observation group was treated with MTX on the basis of the control group.The surgical status,hemodynamic indexes of uterine artery[pulsatility index(PI),resistance index(RI)],sex hormones[luteinizing hormone(LH),follicle stimulating hormone(FSH),estradiol(E_(2))]and postoperative serumβ-human chorionic gonadotropin(β-hCG),occurrence of complications and prognosis were compared between two groups.Result:There was no significant difference in time of curettage between two groups(P>0.05).The amount of intraoperative blood loss in the observation group was less than that in the control group,and the length of hospitalization in the observation group was shorter than that in the control group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse events between two groups(P>0.05).1 month after surgery,there were no significant differences in PI and RI of uterine artery between two groups(P>0.05).1 month after surgery,there were no significant differences in LH and FSH levels between two groups(P>0.05).1 month after surgery,the level of E_(2) in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05).1,3 and 7 d after surgery,the levels ofβ-hCG in both groups were lower than those before surgery,and those in observation group were lower than those in the control group,the differences were statistically significant(P<0.05).The time ofβ-hCG turning negative,duration of vaginal bleeding and postoperative menstrual recovery time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).Conclusion:MTX and uterine artery embolization combined with curettage is beneficial to reduce intraoperative blood loss and incidence of postoperative complications,and shorten hospitalization time in patients with CSP after curettage,which is conducive to postoperative secretions of sex hormones and fast recovery of menstrual cycle.