生殖医学杂志2025，Vol.34Issue(5)：580-587,8.DOI:10.3969/j.issn.1004-3845.2025.05.002
对比手术流产和药物流产的结局及并发症发生率:一项多中心前瞻性队列研究
Comparison of outcomes and incidence of complications between surgical and medical abortion:a multicenter prospective cohort study
摘要
Abstract
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.关键词
手术流产/药物流产/并发症/倾向性评分Key words
Surgical abortion/Medical abortion/Complication/Propensity score matching分类
临床医学引用本文复制引用
江雪,马宏生,邓洋,罗小婉,任凤岩,郭秀玲,戚琪玮,葛军,裴开颜,胡登辉,姜晓梅,Wei-Hong ZHANG,吴尚纯,陈立霞,邵扬琴,张丽娜..对比手术流产和药物流产的结局及并发症发生率:一项多中心前瞻性队列研究[J].生殖医学杂志,2025,34(5):580-587,8.基金项目
中国医学科学院医学与健康创新工程重大协同创新项目(2018-I2M-1-004) （2018-I2M-1-004）
国家卫生健康委科学技术研究所中央级公益性科研院所基本科研业务专项2021年度科技创新基金重点项目(2021GJZ02) （2021GJZ02）
2023年度科技创新重大项目(2023GJZD01) （2023GJZD01）
