子宫动脉栓塞术联合病灶清除术在剖宫产瘢痕妊娠治疗中的应用价值研究

Application value of uterine artery embolization combined with debridement in treatment of caesarean scar pregnancy

目的:探讨子宫动脉栓塞术(UAE)联合病灶清除术在剖宫产瘢痕妊娠(CSP)治疗中的应用价值。方法:选取CSP患者140例为研究对象,随机分为对照组和UAE组,各70例。对照组给予病灶清除术,UAE组给予UAE联合病灶清除术。比较两组围手术期指标,手术前后性激素[卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P)]水平、子宫动脉血流动力学参数、氧化应激指标,术后恢复指标[β-人绒毛膜促性腺激素(β-hCG)恢复时间、月经复潮时间、术后切口肌层厚度和住院时间]及并发症发生情况。结果:UAE组围手术期指标优于对照组(均P<0.05)。两组性激素水平手术前后比较及组间比较差异无统计学意义(均P>0.05)。术后4个月,血管形成指数(VI)两组均低于术前,且UAE组较对照组更低(均P<0.05);两组丙二醛(MDA)水平高于术前,过氧化氢酶(CAT)和超氧化物歧化酶(SOD)水平低于术前(均P<0.05),且组间MDA、CAT和SOD水平比较差异无统计学意义(均P>0.05)。UAE组术后恢复指标优于对照组(均P<0.05)。术后4个月内,两组并发症发生率比较差异无统计学意义(P>0.05)。结论:UAE联合病灶清除术应用于CSP患者能够缩短手术进程,降低术中和术后出血量,对生育功能影响较小,病灶清除更彻底,术后恢复更快,且安全性较好。

Objective:To explore the application value of uterine artery embolization(UAE)combined with debridement in the treatment of caesarean scar pregnancy(CSP).Methods:A total of 140 patients with CSP were enrolled as the research objects,and they were randomly divided into control group(debridement)and UAE group(UAE combined with debridement),70 cases in each group.The perioperative indexes,levels of sex hormones(follicle stimulating hormone[FSH],luteinizing hormone[LH],estradiol[E2],progesterone[P]),uterine arterial hemodynamic parameters,oxidative stress indexes before and after operation,postoperative recovery indexes(recovery time ofβ-human chorionic gonadotropin[β-hCG],re-menstruation time,postoperative incision muscle thickness,hospitalization time)and the occurrence of complications in the two groups were compared.Results:The perioperative indexes in UAE group were better than those in control group(all P<0.05).There was no significant difference in sex hormone levels between pre-operation and postoperaton within the group,between two groups(all P>0.05).Four months after surgery,Vascularization Index(VI)was decreased in both groups(all P<0.05);malondialdehyde(MDA)was increased,while catalase(CAT)and superoxide dismutase(SOD)were decreased in both groups(all P<0.05).There was no significant difference in MDA,CAT or SOD between the two groups(all P>0.05).The recovery indexes in UAE group were better than those in control group(all P<0.05).Within 4 months after surgery,there was no significant difference in incidence of complications between two groups(P>0.05).Conclusion:UAE combined with debridement in CSP patients can shorten the surgical process,reduce intraoperative and postoperative blood loss,has less impact on fertility function.Besides,there is more thorough lesion clearance,faster postoperative recover and better safety.