摘要
目的 评估子宫动脉暂时阻断联合妊娠病灶去除术在治疗Ⅱ型及Ⅲ型剖宫产瘢痕妊娠中的效果,以及该治疗方案对卵巢功能的潜在影响.方法 前瞻性选取2020年2月至2023年2月简阳市人民医院收治的Ⅱ型及Ⅲ型剖宫产瘢痕妊娠患者103例,按照随机数字表法将患者分为对照组(n=51)和研究组(n=52).对照组患者行腹腔镜下妊娠病灶去除术治疗,研究组患者行腹腔镜下子宫动脉暂时阻断联合妊娠病灶去除术治疗.比较两组患者的手术指标(手术时间、术中出血量、住院时间、胚物残留和中转开腹情况)、临床疗效、术后卵巢功能(卵泡刺激素、雌二醇、抗苗勒管激素以及窦卵泡数)和超声检查参数(内膜厚度、搏动指数、阻力指数)情况、术后患者恢复情况(月经恢复正常时间、绒毛膜促性腺激素-β恢复正常时间)及术后并发症发生情况.结果 研究组手术时间为(97.15±12.02)min,长于对照组[(90.26±11.45)min],术中出血量和住院时间分别为(90.46±12.45)mL、(7.11±0.98)d,均短于对照组[(118.26±9.46)mL、(8.45±2.16)d],中转开腹率为0,低于对照组(3.85％),差异均有统计学意义(P＜0.05);两组患者的胚物残留情况比较,差异无统计学意义(P＞0.05).两组患者的治疗有效率比较,差异无统计学意义(P＞0.05).治疗后3个月,两组的卵泡刺激素、雌二醇、抗苗勒管激素以及窦卵泡数水平等卵巢功能指标比较,差异均无统计学意义(P＞0.05).治疗后3个月,两组的内膜厚度、搏动指数、阻力指数等指标比较,差异均无统计学意义(P＞0.05).两组在月经恢复正常时间、绒毛膜促性腺激素-β恢复正常时间及总并发症发生率方面比较,差异均无统计学意义(P＞0.05).结论 与单纯妊娠病灶去除术比较,采用子宫动脉暂时阻断联合妊娠病灶去除术治疗Ⅱ型及Ⅲ型剖宫产瘢痕妊娠手术时间有所延长,但术中出血量及中转开腹率显著降低,对患者的卵巢功能影响较小,术后恢复情况及并发症发生情况与单纯妊娠病灶去除术比较具有相同水平.
Abstract
Objective To explore the effect of temporary blockade of uterine artery occlusion combined with pregnancy lesion removal on type Ⅱ and Ⅲ caesarean section scar pregnancy and the effect on ovarian function.Methods A total of 103 patients with type Ⅱ and Ⅲ cesare-an scar pregnancy admitted to Jianyang Peoples Hospital from February 2020 to February 2023 were prospectively selected and divided into the con-trol group(n=51)and the study group(n=52)according to the random number table method.The control group patients underwent laparo-scopic pregnancy lesion removal,while the study group patients underwent laparoscopic temporary blockade of uterine artery combined with preg-nancy lesion removal for treatment.The surgical indicators(operation time,intraoperative blood loss,hospital stay,embryo residue,and conver-sion to open surgery),clinical officacy,postoperative ovarian function(follicle stimulating hormone,estradiol,anti mullerian hormone,and num-ber of sinus follicles),ultrasound examination parameters(endometrial thickness,pulsatile index,resistance index),postoperative patient recov-ery(menscrual recovery time,chorionic gonadotropin hormone-β recovery time),and incidence of postoperative complications were compared between the two groups of patients.Results The operation time of the study group was(97.15±12.02)min,which was longer than that of the control group[(90.26±11.45)min],the intraoperative blood loss and hospital stay were(90.46±12.45)mL and(7.11±0.98)d,respec-tively,which were shorter than those of the control group[(118.26±9.46)mL,(8.45±2.16)d],the rate of conversion to laparotomy was0,which was lower than that of the control group(3.85％),and the differences were statistically significant(P＜0.05).There was no statistically significant difference in treatment effectiveness between the two groups of patients(P＞0.05).After 3 months of treatment,there were no statisti-cally significant differences in ovarian function indicators such as follicle stimulating hormone,estradiol,anti mullerian hormone,and number of si-nus follicles between the two groups(P＞0.05).After 3 months of treatment,there was no statistically significant difference in the comparison of indicators such as endometrial thickness,pulsatility index,and resistance index between the two groups(P＞0.05).There were no statistical-ly significant differences in the ultrasound indexes such as endometrial thickness,pulsatile index,resistance index between the study group and the control group after 3 months of treatment(P＜0.05).There was no statistically significant difference between the two groups in terms of menstru-al recovery time,chorionic gonadotropin hormone-β recovery time,and overall incidence of complications(P＞0.05).Conclusion Compared with simple pregnancy lesion removal surgery,the use of temporary blockade of uterine artery combined with pregnancy lesion removal surgery for the treatment of type Ⅱ and Ⅲ cesarean scar pregnancy has a longer surgical time,but the intraoperative bleeding volume and conversion rate to open surgery are significantly reduced,which has a smaller impact on the patient's ovarian function.The postoperative recovery and incidence of complications are at the same level as simple pregnancy lesion removal surgery.
NETL
NSTL
万方数据