目的 比较高强度聚焦超声(high intensity focused ultrasound, HIFU)和子宫动脉栓塞术(uterine artery embolization, UAE)治疗剖宫产瘢痕妊娠(cesarean scar pregnancy, CSP)时对卵巢储备功能的影响。方法 采用回顾性研究的方法,选择2013-01至2018-06保定市妇幼保健院收治的CSPⅡ型患者142例,根据治疗前预处理方法不同分为两组,HIFU组96例采用HIFU,UAE组46例采用UAE,预处理后行宫腹腔镜手术,比较两组术前,术后3、6、12个月的血清雌二醇(E₂)、卵泡刺激素(FSH)、促黄体生成素(LH)、抗苗勒管激素(AMH)水平及窦卵泡数(AFC)的变化。比较两组术后患者血HCG在4周内转阴率及5周内月经恢复率。结果 (1)HIFU组不同时间点AMH、FSH、LH、E₂和AFC比较,差异均无统计学意义。(2)UAE组不同时间点E₂差异无统计学意义;而AMH、AFC在UAE后3、6、12个月较术前显著降低;FSH及LH在术后 3、6个月较前明显升高,差异均有统计学意义(P<0.05)。(3)两组相比,术前AMH、FSH、LH、E₂、AFC差异均无统计学意义;UAE组AMH、AFC术后3个月、6个月均低于HIFU组相应时间点,而FSH、LH水平则高于HIFU组,差异均有统计学意义(P<0.05)。(4)HIFU组和UAE组术后5周月经恢复率分别为98.9%和91.3%,两组差异有统计学意义(P<0.05);两组术后4周血β-HCG转阴率比较,差异无统计学意义。结论 HIFU治疗CSP安全有效、无创、可重复,不影响卵巢储备功能,尤其对于有再生育要求的CSP患者更具有重要意义。

Objective To explore the effect of high intensity focused ultrasound (HIFU) and uterine artery embolization (UAE) on ovarian reserve function during the treatment of cesarean scar pregnancy (CSP). Methods One hundred and forty-two patients with CSP Ⅱ treated between January 2013 and June 2018 were selected. According to pretreatment methods, these patients were divided into two groups: the HIFU group (n=96) in which HIFU was used and the UAE group (n=46) where UAE was used. After pretreatment, hysteroscopy and laparoscopy were performed. The levels of serum estradiol (E₂), follicle stimulating hormone (FSH), luteinizing hormone (LH), anti-mullerian hormone (AMH) and the change of antral follicle count (AFC) were observed before operation and 3, 6 and 12 months after operation. These patients were followed up in order to record the side effects. Results (1) There was no statistically significant difference in AMH, FSH, LH, E₂ or AFC between patients in the HIFU group at different time points. (2) In the UAE group, there was no significant difference in E₂ between these patients before or after operation. However, AMH and AFC were significantly lower after 3, 6, 12 months. FSH and LH were significantly higher after 3 months and 6 months, and the difference was statistically significant (P<0.05). (3) There was no significant difference in AMH, FSH, LH, E₂ or AFC between the two groups before operation. AMH and AFC in the UAE group were significantly decreased 3 and 6 months after operation compared with the HIFU group at the corresponding time points. However, FSH and LH levels increased, and the difference was statistically significant (P<0.05). (4)Menstrual recovery rates in the HIFU group and UAE group were 98.9% and 91.3% respectively 5 weeks after operation. The difference between the two groups was statistically significant (P<0.05). There was no significant difference in the recovery rate of blood β-HCG between the two groups 4 weeks after operation. Conclusions HIFU is safe, effective, non-invasive and repeatable during the treatment of CSP, which does not affect ovarian reserve function. HIFU is of special significance for CSP patients who hope for reproduction.