生殖医学杂志

目的 比较药物流产与手术流产临床选择情况及两种方法的完全流产率、不良反应及近期并发症发生率。方法 基于国家卫生健康委科学技术研究所自2019年建立并持续至今的“人工流产女性生育风险前瞻性队列”中2019—2022年纳入的部分研究对象资料，通过对早期人工流产女性的基线数据收集和持续随访，分析早期人工流产女性特征、人工流产方式及相关并发症的发生情况。使用RStudio 1.1.383软件进行统计分析，采用卡方检验对研究对象基本特征进行分析。通过倾向性评分匹配方法，1∶4最邻近匹配药物流产和手术流产，并基于Logistic回归确定两组之间流产结局、不良反应和近期并发症的发生风险比值比(OR)及95%置信区间(95%CI)。结果 共纳入9 231例人工流产女性，平均年龄(28.90±5.10)岁；70.8%已婚，仅有33.9%的女性有生育史。纳入的研究对象中有9 148例资料完整，其中选择药物流产的964例(10.5%),手术流产的8 184例(89.5%)。按照药物流产与手术流产1∶4匹配后，药物流产组964例，手术流产组3 856例。倾向性评分匹配前、后手术流产组完全流产率均显著高于药物流产组[98.1%vs. 86.6%,98.2%vs. 86.6%,OR=0.11,95%CI(0.08,0.16)],匹配后手术流产组流产后包括宫腔积血(2.4%vs. 1.1%)、宫腔粘连或感染(1.1%vs. 0.2%)、月经量异常(1.2%vs. 0.4%)、流产后1～3个月腹痛(1.7%vs. 0.1%)等并发症发生率也显著高于药物流产组(P<0.05),但药物流产组流产过程疼痛评分显著高于手术流产组[(4.45±1.32)分vs.(0.55±0.99)分，P<0.01]。此外，手术流产组术中并发症发生率为4.6‰,其中主要包括人工流产综合反应和多量出血(分别为18例，各占2.2‰),0.7‰的子宫穿孔以及0.9‰的其他术中并发症。结论 手术流产完全流产率高于药物流产，但其相关并发症发生风险也高于后者。虽然各并发症发生率均低于5%,但考虑到人工流产数量和高危人群比例，其实际发生例数及危害值得关注。

Objective:To compare the clinical use of medical abortion versus surgical abortion, as well as the complete abortion rates, adverse reactions, and the incidence of short-term complications associated with the two methods.Methods:The study was based on data from a subset of research subjects enrolled between 2019 and 2022 in the “Prospective Cohort of Female Reproductive Risks After Induced Abortion” established by the National Research Institute for Family Planning, which has been ongoing since 2019. Baseline data collection and continuous follow-up were conducted for women seeking early induced abortion, capturing their characteristics, abortion methods, and related complications. The statistical analysis was performed using RStudio 1.1.383.Chi-square tests were used to analyze the basic characteristics of the study subjects. Propensity score matching was employed with a 1∶4 nearest neighbor matching between medical and surgical abortion groups, and logistic regression was used to determine the odds ratio(OR) and 95% confidence intervals(95%CI) for abortion outcomes, adverse reactions, and the occurrence of short-term complications between the two groups.Results:A total of 9 231 women undergoing induced abortion were included in the study with a mean age of(28.90±5.10) years old. About 70.8% were married and only 33.9% had a history of childbearing. Among the study subjects, 9 148 had complete abortion records, including 964(10.5%) with medical abortion and 8 184(89.5%) with surgical abortion. After matching medical abortion and surgical abortion at a ratio of 1∶4,there were 964 cases in the medical abortion group and 3 856 cases in the surgical abortion group. Before and after propensity score matching, the complete abortion rates in the surgical abortion group were significantly higher than those in the medical abortion group[98.1% vs. 86.6%,98.2% vs. 86.6%,OR=0.11,95%CI(0.08,0.16)]. The surgical abortion group also had significantly higher incidence rates of post-abortion complications, including hematometra(2.4% vs. 1.1%),intrauterine adhesion or infection(1.1% vs. 0.2%),abnormal menstrual amount(1.2% vs. 0.4%),and abdominal pain 1 to 3 months after induced abortion(1.7% vs. 0.1%) when compared with the medical abortion group(P<0.05). However, the pain score during the abortion process was significantly higher in the medical abortion group than that in the surgical abortion group[(4.45±1.32) vs.(0.55±0.99),P<0.01]. In addition, the incidence of intraoperative complications in the surgical abortion group was 4.6‰,primarily including the induced abortion syndrome(18 cases, accounting for 2.2‰) and excessive bleeding(18 cases, accounting for 2.2‰),as well as uterine perforation(0.7‰) and other complications(0.9‰).Conclusions:The surgical abortion has a higher complete abortion rate when compared with the medical abortion, but the risk of complications is also higher. Although the incidence of complications is generally low(below 5%),the actual occurrence and harm of complications should be closely monitored, especially considering the high number of induced abortions and the proportion of high-risk populations.