不同方式治疗Ⅱ型剖宫产瘢痕妊娠对卵巢功能指标及再次发生剖宫产瘢痕妊娠的影响研究

doi:10.3969/j.issn.1006-6233.2022.09.07

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摘要 目的: 探究不同方式治疗Ⅱ型剖宫产瘢痕妊娠(CSP)对卵巢功能指标及再次发生CSP几率的影响。方法: 将我院2018年2月至2021年1月收治的210例Ⅱ型CSP患者作为研究对象,通过随机数字表法将其分为三组(各70例),治疗方案分别为:囊腔内注射甲氨蝶呤(MTX)联合清宫术治疗(A组)、宫腔镜清宫术联合Foley's球囊压迫治疗(B组)、腹腔镜联合宫腔镜治疗(C组)。对比三组的手术时间、术中出血量、住院时间、月经恢复时间、子宫内膜厚度恢复时间。对所有患者进行为期12个月的随访,对比三组内的术后不同时间段的激素指标雌二醇(E2)与卵泡刺激素(FSH)水平、黄体生成素(LH)、窦状卵泡数量,并对比三组间再次妊娠时的CSP发生率。结果: B组术中出血量、住院时间、月经恢复时间、子宫内膜厚度恢复时间均少于A组与C组(P<0.05),A组与B组手术时间均短于C组(P<0.05)。三组在术后不同时间段的月经周期内激素指标E2、FSH、LH水平、窦状卵泡数量均无显著变化(P>0.05)。在术后12个月随访内,B组再次妊娠时的CSP发生率显著低于A组与C组(P<0.05)。结论: MTX联合清宫术、宫腔镜清宫术联合Foley's球囊压迫治疗与腹腔镜联合宫腔镜治疗治疗Ⅱ型CSP,均不会对患者的卵巢功能造成影响,且在3种治疗方式中宫腔镜清宫术联合Foley's球囊压迫治疗能够降低再次发生CSP几率。

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关键词 ： Ⅱ型剖宫产, 囊腔内注射甲氨蝶呤, 宫腔镜, 腹腔镜, 卵巢功能

Abstract：Objective: To investigate the effect of different treatment methods on ovarian function indexes and recurrence of CSP in type Ⅱ cesarean scar pregnancy (CSP). Methods: A total of 210 patients with type II CSP admitted to our hospital from February 2018 to January 2021 were selected as the research subjects,and they were divided into 3 groups (70 cases in each) by random number table method.Injection of methotrexate (MTX) combined with hysterectomy (group A),hysteroscopic hysterectomy combined with Foley's balloon compression therapy (group B),and laparoscopy combined with hysteroscopy (group C).The operation time,intraoperative blood loss,hospital stay,menstrual recovery time,and endometrial thickness recovery time were compared among the three groups.All patients were followed up for 12 months,and the hormone indexes estradiol (E2) and follicle-stimulating hormone (FSH) levels,luteinizing hormone (LH),and antral follicle numbers in different time periods after surgery were compared in the three groups,and the incidence of CSP during re-pregnancy was compared among the 3 groups. Results: Intraoperative blood loss,hospital stay,menstrual recovery time,and endometrial thickness recovery time in group B were less than those in groups A and C (P<0.05),and the operation time in groups A and B were shorter than those in group C (P<0.05).There were no significant changes in the levels of hormone indicators E2,FSH,LH and the number of antral follicles in the menstrual cycle in different time periods after surgery in the three groups (P>0.05).Within 12 months of follow-up,the incidence of CSP in group B was significantly lower than that in groups A and C (P<0.05). Conclusion: MTX combined with evacuation,hysteroscopic evacuation combined with Foley's balloon compression therapy and laparoscopy combined with hysteroscopy in the treatment of type Ⅱ CSP will not affect the ovarian function of patients,and in the three treatment methods,the uterine cavity is not affected.Endoscopic hysterectomy combined with Foley's balloon compression therapy can reduce the chance of recurrence of CSP.

Key words： Type Ⅱ CSP MTX Hysteroscopy Laparoscopy Ovarian function

基金资助:河北省科技支撑计划项目,(编号:202006A010)

引用本文:

张园园, 孙淑红, 于乐, 宫月, 于波, 吉海莲. 不同方式治疗Ⅱ型剖宫产瘢痕妊娠对卵巢功能指标及再次发生剖宫产瘢痕妊娠的影响研究[J]. 河北医学, 2022, 28(9): 1442-1446.
ZHANG Yuanyuan, SUN Shuhong, YU Le, et al. Study on the Effect of Different Treatment Modalities for Type II Caesarean Scar Pregnancy on Ovarian Function Indicators and Recurrence of Caesarean Scar Pregnancy. HeBei Med, 2022, 28(9): 1442-1446.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.09.07 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I9/1442