不同时机应用子宫动脉栓塞在胎盘前置状态引产中的疗效比较  

Curative effect of different timings of applying uterine artery embolization in placenta previa labor induction

作　　者：刘静 齐进 赵麦娟 LIU Jing;QI Jin;ZHAO Mai-Juan(Department of Gynecology,Northwest Women's and Children's Hospital,Xi'an Shaanxi 710061,China;Department of Obstetrics and Gynecology,Fufeng County People's Hospital,Baoji Shaanxi 722200,China)

机构地区：[1]西北妇女儿童医院妇科,陕西西安710061 [2]陕西省扶风县人民医院妇产科,陕西宝鸡722200

出　　处：《临床和实验医学杂志》2020年第17期1868-1872,共5页Journal of Clinical and Experimental Medicine

基　　金：陕西省计生委卫生科研项目(编号:2014D30)。

摘　　要：目的比较不同时机应用子宫动脉栓塞(UAE)在胎盘前置状态引产中的疗效。方法采用回顾性研究方法,选取2016年5月至2019年5月西北妇女儿童医院收治的胎盘前置状态引产患者150例,根据治疗方式不同将其分为两组:A组(n=77)和B组(n=73)。A组患者采用预防性UAE治疗,B组患者采用挽救性UAE治疗。比较两组患者的引产基本情况、分娩方式、并发症、生育能力、手术前后卵巢血供[收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)、阻力指数(RI)、搏动指数(PI)]、卵巢内分泌功能[雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)、泌乳素(PRL)]。结果 (1)A组患者的引产成功率100.00%(77/77)高于B组87.67%(64/73),术中及术后出血量(1 123.49±410.82) ml、(156.79±46.28) ml、子宫切除率1.30%(1/77)、产时大出血发生率2.60%(2/77)均低于B组(2 084.65±579.57) ml、(287.29±45.86) ml、12.33%(9/73)、12.33%(9/73),差异具有统计学意义(P<0.05);(2)A组患者的阴道分娩率97.40%(75/77)高于B组86.30%(63/73),剖宫取胎率2.60%(2/77)低于B组13.70%(10/73),差异具有统计学意义(P<0.05);(3)术后1、4周,A组患者的PSV(36.70±7.56) cm/s、(42.59±9.74) cm/s、EDV(11.60±3.31)cm/s、(11.85±3.57) cm/s、RI(0.65±0.05)、(0.68±0.08)、PI(1.45±0.13)、(1.58±0.39)高于B组(32.82±8.23)(1.20±0.46),差异具有统计学意义(P<0.05);(4)术后1个月,两组患者的血清E2水平(72.49±10.45) pg/ml、(70.62±12.30) pg/ml较术前、术后3个月低,血清FSH(12.03±1.10) IU/L、(12.35±1.15) IU/L、LH(6.79±1.40)IU/L、(7.18±1.16) IU/L、PRL(13.70±4.45) ng/L、(14.38±4.69) ng/L水平较术前、术后3个月高,差异均具有统计学意义(P<0.05);(5)两组患者的并发症发生率、子宫复旧率87.84%(65/74)、79.41%(54/68)、受孕62.16%(46/74)、55.88%(38/68)、自然流产2.70%(2/74)、10.29%(7/68)比较,差异均无统计学意义(P>0.05)。结论预防性UAE、挽救性UAE安全可靠,均能减小对胎盘前置状态引产患�Objective To analyze the effect of different timings of applying uterine artery embolization in placenta previa labor induction.Methods A total of 150 patients with placenta previa labor induction admitted to the northwest women’s and children’s hospital from May 2016 to May 2019 were selected in this retrospective study.According to different treatment methods,they were divided into two groups:group A (n=77)and group B (n=73).Patients in group A were treated with prophylactic UAE,and patients in group B were treated with salvage UAE.The basic conditions of induction of labor,delivery methods,complications,and ovarian blood supply[peak systolic blood flow velocity (PSV),end-diastolic blood flow velocity (EDV),resistance index (RI),and pulsation index (PI)],ovarian endocrine function[estradiol (E2),follicle stimulating hormone (FSH),luteinizing hormone (LH),and prolactin (PRL)]before and after surgery were compared between the two groups.Results (1) The success rate of labor induction in group A was 100.00%(77/77),higher than that in group B[87.67%(64/73)],the intraoperative and postoperative bleeding volume[(1123.49±410.82) ml,(156.79±46.28) ml],hysterectomy rate[1.30%(1/77)],and the incidence of massive hemorrhage during labor[2.60%(2/77)]in group A were lower than those in group B[(2084.65±579.57) ml,(287.29±45.86) ml,12.33%(9/73),12.33%(9/73)],the differences were statistically significant (P<0.05);(2)The vaginal delivery rate of group A was 97.40%(75/77),higher than that of group B[86.30%(63/73)],and the rate of cesarean section of group A was 2.60%(2/77),lower than that of group B[13.70%(10/73)],the differences were statistically significant (P<0.05);(3) At 1 and 4 weeks after surgery,the PSV[(36.70±7.56) cm/s,(42.59±9.74) cm/s],EDV[(11.60±3.31) cm/s,(11.85±3.57) cm/s],RI[(0.65±0.05),(0.68±0.08)],PI[(1.45±0.13),(1.58±0.39)]in group A were higher than those in group B[(32.82±8.23) cm/s,(38.09±9.08) cm/s,(9.83±3.72) cm/s,(10.12±2.86) cm/s,(0.52±0.10),(0.55±0.16),(1.07±0.25),(1.20±0.46)]

关 键 词：胎盘前置状态 引产 子宫动脉栓塞 时机 卵巢血供 卵巢内分泌功能 

分 类 号：R719.3[医药卫生—妇产科学]