Clinical Analysis of Mifepristone Pretreatment Combined with Delayed Hystero-scopic Surgery for Retained Products of Conception Complicated with En-hanced Myometrial Vascularity
10.3969/j.issn.1003-6946.2025.11.017
- VernacularTitle:米非司酮预处理联合延迟宫腔镜手术治疗胚物残留合并子宫肌层血管增强的临床分析
- Author:
Fucheng YANG
1
;
Rui SHI
;
Shuxian FENG
Author Information
1. 中国人民解放军联勤保障部队第九四○医院妇科,甘肃 兰州,730050
- Publication Type:Journal Article
- Keywords:
Enhanced myometrial vascularity;
Retained products of conception;
Hysteroscopic electrotomy;
Mifepristone;
Delayed surgeny
- From:
Journal of Practical Obstetrics and Gynecology
2025;41(11):950-954
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical efficacy of mifepristone pretreatment combined with delayed hysteroscopic surgery for retained products of conception(RPOC)complicated with enhanced myometrial vascu-larity(EMV),aiming to reduce intraoperative bleeding risk and improve patient outcomes.Methods:A retrospec-tive analysis was conducted on clinical data from 65 RPOC patients with EMV treated between June 2014 and June 2024.Patients were divided into an observation group(mifepristone pretreatment+hysteroscopic surgery,n=34)and a control group(hysteroscopic surgery alone,n=31)based on treatment approach.Patients in the observation group received oral mifepristone(25 mg/d)preoperatively until beta-human chorionic gonadotropin(β-hCG)decreased by≥50％or treatment reached 30 days,with surgery performed when β-hCG fell to<200 U/L or EMV area shrank by>50％.Intraoperative blood loss,operation time,reduction in β-hCG levels,degree of EMV regression,and surgical complication rates were compared between the two groups.Results:Intraoperative blood loss was significantly lower in the observation group than in the control group(20.0 ml vs.40.0 ml,P<0.05),op-eration time was shorter(27.38±8.00 min vs.35.45±8.50 min,P<0.05),and transfusion rate was lower(2.94％vs.19.35％,P<0.05).At 2 weeks postoperatively,both the reduction in β-hCG levels(1395.17 U/L vs.276.56 U/L,P<0.05)and the degree of EMV regression(11.6 cm2 vs.5.0 cm2,P<0.05)were significantly bet-ter in the observation group,with effect sizes quantified as large(Cohen's d=1.85)and very large(Cohen's d=3.47),respectively.The incidence of severe complications(Grade Ⅱ+Ⅲ)was significantly lower in the observa-tion group(2.94％vs.22.58％,P<0.05),but the reintervention rate showed no statistical difference(2.94％vs.12.90％,P=0.299).Conclusions:Mifepristone pretreatment creates safer conditions for hysteroscopic surgery by reducing β-hCG levels and shrinking the EMV area.It significantly reduces intraoperative bleeding,shortens op-eration time,and lowers the incidence of severe complications,making it an effective treatment strategy for RPOC patients complicated with EMV.
