子宫动脉栓塞术联合宫腔镜病灶切除术在剖宫产术后瘢痕妊娠治疗中的应用

Application of Uterine Artery Embolization Combined with Hysteroscopic Lesion Resection in the Treatment of Scar Pregnancy After Cesarean Section

目的观察子宫动脉栓塞术(UAE)联合宫腔镜病灶切除术治疗剖宫产术后瘢痕妊娠(CSP)的应用价值。方法选取2019年8月至2021年6月通许第一医院妇产科收治的92例剖宫产后CSP患者作为研究对象,每位患者随机赋予1个数字,按照1∶1配对原则将患者分为两组,各46例。宫腔镜组接受宫腔镜病灶切除术,联合组接受UAE联合宫腔镜灶切除术。观察两组手术指标、血清指标水平、血流动力学、卵巢储备功能及并发症情况。结果联合组手术时间、住院时间、月经恢复时间较宫腔镜组短,术中出血量较宫腔镜组少(P<0.05);术后1周联合组血清指标妊娠相关蛋白A(PAPP-A)、可溶性血管内皮生长因子受体1(SFlt-1)、抑制素A(INH-A)水平低于宫腔镜组(P<0.05);术后1周联合组血流动力学指标搏动指数(PI)、舒张期流速(EDV)、收缩期峰值流速(PSV)低于宫腔镜组(P<0.05);术后8周联合组卵巢储备功能指标窦状卵泡数(AFC)、雌二醇(E)、抗米勒管激素(AMH)低于宫腔镜组,促卵泡成熟激素(FSH)高于宫腔镜组(P<0.05);联合组并发症发生率(6.52%)与宫腔镜组(10.86%)比较,差异无统计学意义(P>0.05)。结论UAE联合宫腔镜病灶切除术能优化CSP患者手术情况,改善局部血液循环,减轻卵巢储备功能损伤,促进术后恢复。

Objective To observe the value of uterine artery embolization(UAE)combined with hysteroscopic lesion resection in the treatment of cesarean scar pregnancy(CSP)after cesarean section.Methods A total of 92 patients with CSP after cesarean section admitted to the Department of Obstetrics and Gynecology of Tongxu First Hospital from August 2019 to June 2021 were selected as the research objects.Each patient was randomly assigned a number.According to the 1∶1 matching principle,the patients were divided into two groups,with 46 cases in each group.The hysteroscopic group received hysteroscopic lesion resection,and the combined group received UAE combined with hysteroscopic lesion resection.The operation index,serum index level,hemodynamics,ovarian reserve function and complications were observed in the two groups.Results The operation time,hospital stay,menstrual recovery time in the combined group were shorter than those in the hysteroscopy group,the intraoperative bleeding volume in the combined group were smaller than that in the hysteroscopy group(P<0.05).One week after operation,the serum levels of pregnancy-associated plasma protein-A(PAPP-A),soluble fms-like tyrosine kinase-1(SFlt-1)and inhibin-A(INH-A)in the combined group were lower than those in the hysteroscopy group(P<0.05).One week after operation,the hemodynamic indexes of pulse index(PI),end diastolic velocity(EDV)and systolic peak systolic velocity(PSV)in the combined group were lower than those in the hysteroscopy group(P<0.05).At 8 weeks after operation,the number of antral follicular count(AFC),estradiol(E),and anti-Müllerian hormone(AMH)in the combined group were lower than those in the hysteroscopic group,and the follicle-stimulating hormone(FSH)was higher than those in the hysteroscopic group(P<0.05).There was no statistical significance difference in the incidence of complications between the combined group(6.52%)and the hysterosopic group(10.86%)(P>0.05).Conclusion UAE combined with hysteroscopic lesion resection can optimize the operation of CSP patients,improve local blood circulation,reduce the damage of ovarian reserve function,and promote postoperative recovery.