甲氨蝶呤联合宫-腹腔镜下瘢痕切除术治疗剖宫产后瘢痕妊娠疗效及对子宫动脉血流动力学、卵巢功能的影响

Effect of methotrexate combined with hysteroscopic scarectomy on scar pregnancy after cesarean section and its effect on uterine artery hemodynamics and ovarian function

目的探讨甲氨蝶呤联合宫-腹腔镜下瘢痕切除术治疗剖宫产后瘢痕妊娠(CSP)的疗效及对子宫动脉血流动力学、卵巢功能的影响。方法选取2018年1月至2021年1月期间就诊于沧州市人民医院的100例CSP患者,随机分为两组,其中接受甲氨蝶呤+超声引导下清宫术处理的50例患者为对照组,接受甲氨蝶呤+宫-腹腔镜下瘢痕切除术处理的50例患者为观察组。比较两组手术疗效、术中及术后恢复指标、子宫动脉血流动力学、卵巢功能及并发症发生情况。结果观察组治疗总有效率显著高于对照组(100.00%vs.86.00%,P<0.05);与对照组比较,观察组术后第1次月经来潮、血清HCG恢复正常及住院时间均显著缩短,术中出血量显著减少(P<0.05);两组术后血流动力学参数PI均显著升高、RI均显著降低(P<0.05),且观察组术后PI升高更显著(P<0.05);两组间术后血清FSH、E 2水平及窦卵泡计数比较均无显著差异(P>0.05);观察组术后并发症发生率显著低于对照组(P<0.05)。结论甲氨蝶呤联合宫-腹腔镜下瘢痕切除术治疗CSP疗效显著,可有效促进患者血管弹性水平恢复,且对卵巢功能无明显影响,具有积极的临床应用价值。

Objective:To investigate the effect of methotrexate combined with hystero-laparoscopic scarectomy on post-cesarean scar pregnancy(CSP)and its influence on uterine artery hemodynamics and ovarian function.Methods:A hundred CSP patients who were treated in Cangzhou People’s Hospital from January 2018 to January 2021 were selected.They were randomly divided them into two groups:50 patients who received methotrexate+ultrasound-guided curettage as the control group,and 50 patients who received methotrexate+hystero-laparoscopic scarectomy as the observation group.The operation effect,recovery index during and after operation,uterine artery hemodynamics,ovarian function and complications were compared between the two groups.Results:The total effective rate of treatment in the observation group was significantly higher than that in the control group(100.00%vs 86.00%,P<0.05).Compared with the control group,the first menstrual cycle,serum HCG return to normal,and hospitalization time were significantly shortened after surgery,and intraoperative bleeding was significantly reduced in the observation group(P<0.05).The hemodynamic parameters PI significantly increased and RI significantly decreased in both groups(P<0.05),and the postoperative PI elevation in the observation group was more significant(P<0.05).There was no significant difference in serum levels of FSH&E 2 and antral follicle count between the two groups(P>0.05).The incidence of postoperative complications in the observation group was significantly lower than that in the control group(P<0.05).Conclusions:Methotrexate combined with hystero-laparoscopic scarectomy has a significant effect on the treatment of CSP,which can effectively promote the recovery of vascular elasticity,and has no significant impact on ovarian function.It has positive clinical application value.