The Efficacy Of Uterine Artery Embolization Combined With Different Local Infusion Chemotherapy In Treatment Of Ectopic Pregnancy

Background:Ectopic pregnancy(EP),one of the common emergencies in obstetrics and gynecology,refers to the pregnancy of fertilized eggs outside the normal endometrium.It has been known as one of the leading causes of death in the first three months of pregnancy.Over the past 50 years,the incidence of EP has increased significantly,andtends to be younger.And the incidence of EP after cesarean section and assisted reproduction(ART)has increased significantly.The clinical manifestations of EP include a small amount of vaginal bleeding,slight abdominal pain and hemorrhagic shock resulting from rupture of the gestational sac,which seriously threatens the life of the patient and leads to severe complications and unavoidable damage to reproductive functions.Therefore,safe and effective treatment measures which can protect the anatomy of the patient's reproductive system as much as possible should be selected correctly.In 1990,Lobel successfully treated a case about cervical pregnancy(CP)with uterine artery embolization(UAE),avoiding excision of uterus and retaining the patient's potential for future fertility.With decades of development on this basis,uterine arterial chemoembolization(UACE)has been widely used in the treatment of EP,but there is no uniform standard for drug selection in UACE treatment.Methotrexate(MTX)is the choice drug for conservative treatment of EP,and5-fluorouracil(5-Fu)is also effective for the treatment of EP.Therefore,we compared the efficacy of UAE combined with MTX and UAE combined with MTX+5-Fu to explore a standardized program about minimally invasive treatment of EP.With the wide application of UAE in clinical practice,it is hoped that there willl be more understanding of subsequent pregnancy of patients,meanwhile the impact on the subsequent pregnancy of patients is not consistent.Therefore,menstrual recovery after treatment,the change in follicle stimulating hormone(FSH)and luteinizing hormone(LH)at 3 months after UACE and re-pregnancy within 1 year need to be followed up.Objective:1.To compare the clinical efficacy and side-effect of UAE combined with MTX and UAE combined with MTX+5-Fu and explore a standardized program about minimally invasive treatment of EP.2.To Follow up menstrual recovery,the change in FSH and LH after UACE and re-pregnancy within1 year of patients with UACE in order to assess the effect on ovarian function.Methods:A randomized,controlled clinical research was carried out.88 EP patients diagnosed by clinical examination,?-Human chorionic onadotropin(?-HCG)and transvaginal ultrasound scan(TVS)were randomly divided into control group(UAE combined with MTX)and test group(UAE combined with MTX+5-Fu).We detected serum?-HCG value.And the cure rate,cure time,menstrual recovery time and the quantity,the change in FSH and LH after treatment,re-pregnancy within 1 year after UACE and adverse reaction were recorded.Analysis of variance(ANOVN)was applied to the repeated measurement data.Comparison between groups was performed using?2 test.When the measurement data between the two groups was in accordance with normal distribution and homogeneity of variance,t-test was used.Correlation analysis was applied to two variables.Results:There was no significant difference in serum?-HCG on the main effects and time interactions in the treatment between the control group and the test group,which was not statistically significant,the control group and the test group are effectice.The healing time of the control group and the test group was:24.58±10.95d,24.66±9.72d,with no statistical difference.The cure rates of the control group and the test group were 95.34%and 91.11%respectively,with no statistical difference.There were no serious adverse events in two groups.The incidence of adverse events was 25.58%(control group)and 57.78%(test group),with statistically significant differences.The correlation coefficient between preoperative serum?-HCG and treatment success rate was-0.988,with a linear correlation.The menstrual recovery time was36.80d±10.20d(controlgroup)and35.29±10.81(testgroup),whichwerenot statistically significant.Changes in FSH and LH before and after treatment in the two groups were not statistically significant.In the 12 months after treatment,there were13 patients who had the intention of conception and no basic diseases,9 were pregnant,and the rate of repregnancy was 69.23%.In the failed cases,the serum?-HCG changes were polymorphic.Conclusions:1.There is no difference in the clinical efficacy of UAE combined with MTX and UAE combined with MTX+5-Fu.However the test group has higher adverse reactions than the control group.It is recommended that UAE combined with MTX(50mg/m~2)should be chosen in the minimally invasive treatment of EP;2.After UACE treatment,the changes of serum?-HCG are polymorphic,and alternative treatment options may be selected as additional treatment if necessary;3.The results of this study showed that the rate of repregnancy was 69.23%for patients with no basic diseases after treatment of UACE,but the sample size was relatively small,and it was necessary to continue to observe to determine the effect on fertility function.