子宫动脉栓塞术对不同年龄阶段剖宫产术后子宫瘢痕妊娠患者卵巢功能的影响

Effect of uterine artery embolization on ovarian function in patients with cesarean scar pregnancy in different age stages

目的 探讨子宫动脉栓塞术对不同年龄阶段剖宫产术后子宫瘢痕妊娠患者卵巢功能的影响,为临床治疗提供个性化的利于患者生育力保护的方案。方法 选择2017年7月至2021年7月就诊于西安交通大学第二附属医院的128例剖宫产术后子宫瘢痕妊娠患者作为研究对象,按年龄分为A组(年龄<35岁)和B组(年龄≥35岁),根据各组是否接受子宫动脉栓塞术又分为A1对照组(米非司酮+宫腔镜下瘢痕病灶清除32例),A2观察组(米非司酮+子宫动脉栓塞术+宫腔镜下瘢痕病灶清除32例);B1对照组(米非司酮+宫腔镜下瘢痕病灶清除32例),B2观察组(米非司酮+子宫动脉栓塞术+宫腔镜下瘢痕病灶清除32例)。对上述各组病例的术前,术后1月、3月、6月抗苗勒管激素(anti-Müllerian hormone, AMH)、窦卵泡数(antral follicle count, AFC)、卵泡刺激素(follicle stimulating hormone, FSH)、雌二醇(estradiol, E)进行组间、组内比较。结果 组间比较:A1组与A2组相比,两组术前,术后1月、3月、6月AMH、AFC、FSH、E值差异均无统计学意义(P>0.05);B1组与B2组相比,两组术前AMH、AFC、FSH、E值差异无统计学意义(P>0.05),但术后1月、3月、6月AMH、AFC、FSH值差异有统计学意义(P<0.05),术后各个阶段E值差异无统计学意义(P>0.05)。组内比较:A1组、A2组、B1组各组术后1月、3月、6月的AMH、AFC、FSH、E值与术前相比,差异均无统计学意义(P>0.05),但B2组术后1月、3月、6月的AMH、AFC、FSH值与术前相比,差异有统计学意义(P<0.05),B2组术后1月、3月、6月E值与术前相比,差异无统计学意义(P>0.05)。结论 在低于35岁的女性中,子宫动脉栓塞术的治疗对其自身卵巢功能没有影响,但在高龄女性中(年龄≥35岁),子宫动脉栓塞术的治疗会明显影响其自身卵巢功能且使其进一步减退。

Objective To investigate the effect of uterine artery embolization on ovarian function of patients with cesarean scar pregnancy in different age stages, and to provide personalized fertility protection plan for clinical treatment.Methods A total of 128 patients with cesarean scar pregnancy who received treatment in the Second Affiliated Hospital of Xi’an Jiaotong University from July 2017 to July 2021 were selected as the research subjects.They were divided into group A(age<35 years old) and group B(age ≥35 years old) according to age, and according to whether they received uterine artery embolization or not were further divided into: A1 control group(mifepristone+hysteroscopic scar lesion removal in 32 cases),A2 observation group(mifepristone+uterine artery embolization+hysteroscopic scar lesion removal in 32 cases);B1 control group(mifepristone+hysteroscopic scar lesion removal in 32 cases),B2 observation group(mifepristone+uterine artery embolization+hysteroscopic scar lesion removal in 32 cases).The anti-Müllerian hormone(AMH),antrol follicle count(AFC),follicle stimulating hormone(FSH) and estradiol(E) were compared between groups and within groups before operation and at 1,3 and 6 months after operation.Results Comparison between groups: there were no significant differences in AMH,AFC,FSH and Evalues between A1 group and A2 group before operation and at 1,3 and 6 months after operation(P>0.05).There were no statistically significant differences in preoperative AMH,AFC,FSH and Evalues between between B1 group and B2 group(P>0.05),but there were statistically significant differences in AMH,AFC and FSH values at 1,3 and 6 months after operation(P<0.05),and no statistically significant differences in Evalues at each stage after operation(P>0.05).Intra-group comparison: there were no statistically significant differences in AMH,AFC,FSH and Evalues at 1,3 and 6 months after operation compared to preoperative in groups A1,A2 and B1(P>0.05),but there were statistically significant differences in AMH,AFC and FSH values at 1,3 and 6 months after operation in group B2(P<0.05).There was no significant difference in Evalues in group B2 at 1,3 and 6 months after operation compared with those before operation(P>0.05).Conclusion In women younger than 35,uterine artery embolization has no effect on ovarian function, but in older women(age≥35 years old),uterine artery embolization significantly affects ovarian function and further decreases it.