摘要
目的比较宫腔镜治疗前联合子宫动脉栓塞术(UAE)或甲氨蝶呤(MTX)与直接宫腔镜治疗剖宫产瘢痕妊娠(CSP)的有效性和安全性。方法回顾性选取2016年1月至2019年12月在金华市中心医院就诊的内生型胚囊(Ⅰ型)CSP患者173例,将其分为三组,A组61例直接行宫腔镜治疗,B组59例子宫动脉栓塞术后行宫腔镜治疗,C组53例甲氨蝶呤(MTX)全身性给药后行宫腔镜治疗。比较三组患者术中及术后相关情况、手术前后卵巢功能。结果A组患者的失血量明显高于B组和C组,A组有2例患者在手术过程中发生了大出血,其中1例需要输血;C组有1例大出血,但无需输血。与B组和C组比较,A组的住院时间明显缩短,医疗费用更低、副反应更少(P<0.001)。此外,在高龄(≥35岁)女性中,B组患者术后血清AMH水平明显低于术前(P<0.001),并显著低于A组和C组(P<0.05)。结论对于Ⅰ型CSP患者,直接宫腔镜治疗是一种可靠的治疗方法。在这些患者中,宫腔镜治疗前使用子宫动脉栓塞术或甲氨蝶呤的治疗效果有限,并且子宫动脉栓塞术会降低35岁以上女性的卵巢储备功能。
Objective To compare the efficacy and safety of uterine artery embolization(UAE)or methotrexate(MTX)before hysteroscopy combined with direct hysteroscopy in the treatment of cesarean scar pregnancy(CSP).Methods A total of 173 endogenic embryo sac(type Ⅰ)CSP patients who were admitted to Jinhua Central Hospital from January2016 to December 2019 were retrospectively selected and divided into 3 groups.In group A,61 patients were treated with hysteroscopy.In group B,59 patients were treated with hysteroscopy after uterine artery embolization.In group C,53 patients were treated with hysteroscopy after systemic administration of methotrexate(MTX).The intraoperative and postoperative conditions and ovarian function before and after operation were compared among the three groups.Results The blood loss of group A was significantly higher than those of group B and group C.Two patients in group A suffered from massive bleeding during the operation,of which 1 patient needed blood transfusion.In group C,1 patient suffered from massive hemorrhage,but blood transfusion was not required.Compared with group B and group C,the length of hospitalization in group A was significantly shortened,the medical cost was lower and the side effects were less(P<0.001).In addition,among elderly women(≥35 years old),the serum AMH levels of patients in group B were significantly lower those that before surgery(P<0.001),and significantly lower than those in groups A and C(P<0.05).Conclusion For patients with typeⅠCSP,direct hysteroscopy is a reliable treatment.In these patients,uterine artery embolization or methotrexate prior to hysteroscopic treatment has limited efficacy,and uterine artery embolization reduces ovarian reserve in women over 35 years of age.
作者
金兰英
季丽梅
邵明君
冯蓓
JIN Lanying;JI Limei;SHAO Mingjun;FENG Bei(Department of Gynecology,Jinhua Central Hospital of Zhejiang Province,Jinhua 321000,China;Department of Ultrasound,Jinhua Central Hospital of Zhejiang Province,Jinhua 321000,China)
出处
《中国现代医生》
2022年第5期60-63,68,共5页
China Modern Doctor
基金
浙江省医药卫生科技计划项目(2021KY388)
浙江省金华市科技计划项目(2018-4-010)。
