腹腔镜下子宫动脉结扎术与子宫动脉栓塞术在剖宫产术后子宫瘢痕妊娠中的治疗效果比较

Comparison of the Therapeutic Effects of Laparoscopic Uterine Artery Ligation and Uterine Artery Embolization in Uterine Scar Pregnancy After Cesarean Section

目的比较腹腔镜下子宫动脉结扎术与子宫动脉栓塞术在剖宫产术后子宫瘢痕妊娠(CSP)中的治疗效果。方法选取2022年1月-6月我院妇科收治的58例CSP患者为研究对象,采用随机数字表法分为对照组和观察组,每组29例。对照组采用子宫动脉栓塞术治疗,观察组采用腹腔镜下子宫动脉结扎术,两组术后均进行瘢痕病灶切除修补术。比较两组治疗效果、手术指标、术后卵巢功能指标以及治疗安全性。结果观察组治疗总有效率为93.10%,高于对照组的82.76%(P<0.05);观察组手术时间、术中出血量、术后血β-hCG恢复正常时间、住院时间、住院费用、月经复潮时间均小于对照组(P<0.05);两组24 h血β-hCG下降百分率比较,差异无统计学意义(P>0.05);两组术后FSH、LH均高于术前,T、E_(2)、AMH、窦卵泡数均低于术前,但观察组FSH、LH低于对照组,T、E_(2)、AMH、窦卵泡数高于对照组(P<0.05);观察组术后并发症发生率为6.90%,低于对照组的17.24%(P<0.05)。结论与子宫动脉栓塞术比较,腹腔镜下子宫动脉结扎术治疗CSP可提高治疗总有效率,减少术中出血量,缩短手术、住院以及血β-hCG恢复正常时间,降低住院费用、并发症发生率,且对卵巢功能损伤更小,有利于卵巢功能保护,值得临床应用。

Objective To compare the therapeutic effects of laparoscopic uterine artery ligation and uterine artery embolization in cesarean scar pregnancy(CSP).Methods From January to June 2022,58 patients with CSP admitted to gynecology department of our hospital were selected as the research objects.They were divided into control group and observation group by random number table method,with 29 cases in each group.The control group was treated with uterine artery embolization,and the observation group was treated with laparoscopic uterine artery ligation.Both groups underwent scar resection and repair.The therapeutic effect,surgical indicators,postoperative ovarian function indicators and treatment safety were compared between the two groups.Results The total effective rate of treatment in the observation group was 93.10%,which was higher than 82.76%in the control group(P<0.05).The operation time,intraoperative blood loss,postoperative bloodβ-hCG recovery time,hospitalization time,hospitalization expenses and menstrual recovery time in the observation group were less than those in the control group(P<0.05).There was no significant difference in the percentage of 24 h bloodβ-hCG decline between the two groups(P>0.05).The levels of FSH and LH in the two groups were higher than those before operation,and the levels of T,E_(2),AMH and antral follicle count were lower than those before operation,but the levels of FSH and LH in the observation group were lower than those in the control group,and the levels of T,E_(2),AMH and antral follicle count were higher than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was 6.90%,which was lower than 17.24%in the control group(P<0.05).Conclusion Compared with uterine artery embolization,laparoscopic uterine artery ligation for CSP can improve the total effective rate of treatment,reduce the amount of intraoperative blood loss,shorten the time of operation,hospitalization and bloodβ-hCG recovery,reduce the cost of hospitalization and the incidence of complications,and have less damage to ovarian function,which is conducive to the protection of ovarian function and is worthy of clinical application.