腹腔镜子宫动脉暂时阻断术对III型剖宫产瘢痕部位妊娠患者术中出血量和卵巢功能的影响
| 作者: |
1程小丰,
1李荣,
1何辉
1 池州市人民医院妇产科，安徽 池州 247000 |
| 通讯: |
程小丰
Email: 94134203@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2021.04.012 |
摘要
目的：探讨腹腔镜子宫动脉暂时阻断术对III型剖宫产瘢痕部位妊娠(cesarean scar pregnancy，CSP)患者术中出血量和卵巢功能的影响。方法：回顾性分析2015年2月至2019年12月期间本院妇产科收治的48例III型CSP患者的临床资料，其中23例接受腹腔镜子宫动脉暂时阻断术+病灶切除术治疗，余下25例接受子宫动脉栓塞术(uterine artery embolization，UAE)+病灶切除术治疗，分别记为子宫动脉阻断组(n=23)和UAE组(n=25)，术后对症治疗和随访观察均相同。比较两组手术时间、术中出血量、住院情况、术后血人绒毛膜促性腺激素(β-human chorionic gonadotropin，β-hCG)水平变化、月经恢复时间等手术相关指标，术后3~4 d复查时检测血清促卵泡成熟激素(follicle stimulating hormone，FSH)、黄体生成激素(luteinizing hormone，LH)、雌二醇(estradiol，E2)水平评估卵巢功能。结果：两组均成功完成手术，手术时间、术后首次复查β-hCG下降百分比、β-hCG恢复正常时间、月经恢复时间、月经恢复时间和并发症率比较，差异均无统计学意义(P>0.05)，子宫动脉阻断组术后住院时间、住院费用均少于UAE组，差异有统计学意义(P<0.05)；两组术前和术后3~4 d血清FSH、LH、E2水平比较，差异无统计学意义(P>0.05)。结论：腹腔镜下子宫动脉暂时阻断术能有效减少III型CSP患者术中出血量，对卵巢功能无明显影响，住院成本较低，是一种安全可靠的预处理手段。
关键词：
III型剖宫产瘢痕部位妊娠；子宫动脉预处理；腹腔镜子宫动脉暂时阻断术；子宫动脉栓塞术；术中出血量；人绒毛膜促性腺激素；卵巢功能
Effect of laparoscopic uterine artery temporary occlusion on intraoperative blood loss and ovarian function in patients with type III cesarean scar pregnancy
CorrespondingAuthor: CHENG Xiaofeng Email: 94134203@qq.com
DOI: 10.3978/j.issn.2095-6959.2021.04.012
Abstract
Objective: To investigate the effect of laparoscopic uterine artery temporary occlusion on intraoperative blood loss and ovarian function in type III cesarean scar pregnancy (CSP). Methods: The clinical data of 48 patients with type III CSP admitted to our hospital from February 2015 to December 2019 was retrospectively analyzed. Among them, 23 cases were treated with laparoscopic uterine artery temporary occlusion and lesion resection, and the remaining 25 cases were treated with uterine artery embolization (UAE) and lesion resection, which were respectively recorded as uterine artery occlusion group (n=23) and UAE group (n=25). Symptomatic treatment and follow-up observation were the same between the two groups after operation. Operation related indexes such as the operation time, intraoperative blood loss, hospital stay, postoperative changes of serum β-human chorionic gonadotropin (β-hCG) level and menstrual recovery time were compared between the two groups. The levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) in serum were detected during the reexamination 3–4 days after operation to evaluate the ovarian function. Results: The operation was successfully completed in both groups. There was no significant difference in the operation time, the percentage of decrease of β-hCG in the first postoperative reexamination, the recovery time of β-hCG, the recovery time of menstruation, and the complication rate (P>0.05). The length of hospital stay and hospitalization expenses in uterine artery occlusion group were significantly lower than those in UAE group, which showed a statistically significant difference (P<0.05). There was no significant difference in the levels of serum FSH, LH and E2 between the two groups before and 3–4 d after operation (P>0.05). Conclusion: Laparoscopic uterine artery temporary occlusion can effectively reduce the intraoperative blood loss of patients with type III CSP, and has no significant impact on ovarian function. It is a safe and reliable pretreatment method with low hospitalization cost.
Keywords：
type III cesarean scar pregnancy; uterine artery pretreatment; laparoscopic uterine artery temporary occlusion; uterine artery embolization; intraoperative blood loss; serum β-human chorionic gonadotropin; ovarian function