子宫动脉栓塞术联合超声引导下清宫术对剖宫产切口瘢痕妊娠患者性激素和卵巢功能的影响

Effect of uterine artery embolization combined with ultrasound-guided curettage on sex hormones and ovarian function in patients with cesarean scar pregnancy

摘要:

目的 探讨子宫动脉栓塞术（UAE）联合超声引导下清宫术对剖宫产切口瘢痕妊娠（CSP）患者性激素和卵巢功能的影响。方法 选取2021年1月—2024年1月在眉山市人民医院就诊的98例CSP患者为研究对象，采用随机数字表法分为观察组和对照组，各49例。对照组给予超声引导下清宫术，观察组在对照组基础上联合UAE治疗。记录两组手术时间、术中出血量、阴道出血时间、住院时间等围手术期指标，并比较两组术后恢复情况，以及术前和术后6个月的性激素水平［雌二醇（E2）、黄体生成素（LH）、卵泡刺激素（FSH）］和卵巢储备功能［卵巢最大平面平均直径（MOD）、抗苗勒管激素（AMH）、窦卵泡计数（AFC）］，同时记录患者术后不良反应发生情况（腹痛、大出血、二次清宫）。结果 观察组手术时间、术中出血量、阴道出血时间和住院时间均低于对照组（P <0.05）。观察组β-hCG恢复时间、月经复潮时间均低于对照组（P <0.05）。对照组与观察组手术前后E2、LH、FSH、MOD、AMH、AFC的差值比较，差异均无统计学意义（P >0.05）。观察组不良反应总发生率低于对照组（P <0.05）。结论 CSP患者采用UAE联合超声引导下清宫术，可减少术中出血量，加快康复时间，且不会影响患者术后卵巢功能。

Abstract:

Objective To investigate the effects of uterine artery embolization (UAE) combined with ultrasound-guided curettage on sex hormones and ovarian function in patients with cesarean scar pregnancy (CSP).Methods The 98 CSP patients treated at our hospital between January 2021 and January 2024 were selected. They were assigned into two groups by the random number table method, each consisting of 49 individuals. The control group received ultrasound-guided curettage alone, while the observation group additionally received UAE treatment. Perioperative parameters such as operative duration, intraoperative blood loss, duration of vaginal bleeding, and length of hospital stay were recorded. Postoperative recovery, and levels of sex hormones [estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH)] and ovarian reserve functions [mean ovarian diameter (MOD), anti-Müllerian hormone (AMH), and antral follicle count (AFC) ] before and 6 months after surgery were compared. Additionally, postoperative adverse reactions (abdominal pain, massive hemorrhage, secondary curettage) were documented.Results The observation group showed significantly shorter operative duration, less intraoperative blood loss, and shorter duration of vaginal bleeding and length of hospital stay compared with the control group (P < 0.05). The β-hCG recovery time and menses resumption time in the observation group were also significantly shorter than those in the control group (P < 0.05). The differences of E2, LH, FSH, MOD, AMH, and AFC before and after surgery were not different between the control and observation groups (P > 0.05). The overall incidence of adverse reactions in the observation group was significantly lower than that in the control group (P < 0.05).Conclusion The combination of UAE and ultrasound-guided curettage in the treatment of CSP can reduce intraoperative blood loss, accelerate recovery time, and does not affect postoperative ovarian function.