子宫动脉栓塞术预处理在剖宫产瘢痕妊娠患者中的应用效果及对再妊娠结局的影响

Efficacy of pretreatment with uterine artery embolization in patients with cesarean scar pregnancy and its effect on re-pregnancy outcome

目的探讨子宫动脉栓塞术预处理在剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)患者中的应用及对其超声图像特征、血清生化指标及再妊娠结局的影响。方法回顾性选取2015年1月至2017年1月在武汉市红十字会医院行清宫术且符合纳排标准的CSP患者,将直接行超声介导下清宫术的30例CSP患者纳入对照组,行子宫动脉栓塞术预处理随后行超声介导下清宫术的30例CSP患者纳入观察组。观察两组手术完成情况、术后恢复情况及手术前后超声图像特征、超声定量参数[血流指数(flow index,FI)、血管形成指数(vascular index,VI)、血管形成-血流指数(blood vessels and blood flow index,VFI)]、激素水平[卵泡生成激素(follicle-stimulating hormone,FSH)、雌二醇(estradiol,E2)、睾酮(testoserone,T)]及再妊娠情况。结果两组二次清宫、大出血、中转开腹及子宫切除率比较,差异无统计学意义(P>0.05);观察组术后住院、阴道出血、月经复潮及β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-hCG)转阴时间均短于对照组(P<0.05);两组术前腹部联合阴道超声检查结果差异无统计学意义(P>0.05),术后观察组切口平均厚度低于对照组;相较于术前,两组FI、VI、VFI均明显改善(P<0.05),但组间比较差异无统计学意义(P>0.05);术后3个月观察组FSH、E2、T水平高于对照组(P<0.05);观察组再妊娠间隔时间较对照组短,自然妊娠率较对照组高(P<0.05)。结论子宫动脉栓塞预处理在治疗CSP患者方面存在一定优势,具有创伤小、康复快等特点,有助于保留卵巢功能,促进术后再妊娠。相对于单纯清宫术,在其之前进行子宫动脉栓塞预处理值得推广。

Objective To investigate the use of uterine artery embolization pretreatment in patients with cesarean scar pregnancy(CSP)and the effect on ultrasound image characteristics,serum biochemical indices and re-pregnancy outcome.Methods Retrospectively selected CSP patients meeting the criteria for natriuresis who underwent hysterectomy in Wuhan Red Cross Hospital between January 2015 and January 2017,30 CSP patients who underwent direct ultrasound-mediated hysterectomy were included in the control group,and 30 CSP patients who underwent uterine artery embolisation pretreatment followed by ultrasoundmediated hysterectomy were included in the observation group.Observed the completion of the procedure,postoperative recovery and the characteristics of ultrasound images before and after the procedure,and the quantitative ultrasound parameters[flow index(FI),vascular index(VI),blood vessels and blood flow index(VFI)J,hormone levels[follicle-stimulating hormone(FSH),estradiol(E,),testosterone(testoserone,T)J,and recurrent pregnancy of both groups.Results There was no statistically significant difference between the two groups in terms of secondary clearance,hemorrhage,intermediate open abdomen and hysterectomy rate(P>0.05);postoperative hospitalization,vaginal bleeding,menstrual return andβ-human chorionic gonadotropin(β-hCG)conversion time were shorter in the observation group than in the control group(P<0.05);there was no significant difference between the two groups in terms of preoperative abdominal combined vaginal ultrasound findings(P>0.05).The mean thickness of incision was lower in the observation group than in the control group;compared with the preoperative period,VI,FI and VFI were significantly improved in both groups(P<0.05),but there was no statistical significance between the groups(P>0.05);the levels of FSH,E,and T were higher in the observation group than in the control group at 3 months after surgery(P<0.05);the interval of re-pregnancy was shorter in the observation group than in the control group,and the spontaneous pregnancy rate was higher in the observation group than in the control group(P<0.05).Conclusionn Compared with simple uterine clearance uterine artery embolization pretreatment has certain advantages in the treatment of patients with CSP,with less trauma and faster recovery,which helps to preserve ovarian function and promote postoperative re-pregnancy.Compared with simple uterine clearance,uterine artery embolization pretreatment before is worthy of promotion.