高强度聚焦超声与子宫动脉栓塞辅助负压吸宫术治疗剖宫产瘢痕部位妊娠的有效性和安全性比较

High-intensity focused ultrasound assisting suction curettage therapy and uterine artery embolization assisting suction curettage therapy in the treatment of cesarean scar pregnancy: a comparison of the effectiveness and safety

目的对比高强度聚焦超声(HIFU)与子宫动脉栓塞(UAE)辅助负压吸宫术治疗剖宫产瘢痕部位妊娠(CSP)的效果和安全性。方法回顾性分析2015年10月至2017年10月在遵义医学院附属医院确诊为CSP并接受治疗的116例患者,其中55例患者接受HIFU(HIFU组)辅助治疗联合负压吸宫术,61例患者接受UAE(UAE组)辅助治疗联合负压吸宫术。结果 HIFU组吸宫术中出血量和住院花费分别为(18.74±7.21)mL及(5026.28±1683.81)元,UAE组吸宫术中出血量和住院花费分别为(106.07±23.28)mL及(12 482.07±3461.63)元,HIFU组显著低于UAE组(P<0.01)。HIFU组41例患者治疗后出现下腹和腰骶部疼痛,发生率显著高于UAE组(13例);下肢痛、呕吐和发热的发生率低于UAE组;HIFU组患者吸宫术后阴道流血时间(12.37±3.42)d,显著低于UAE组(14.61±5.46)d(P<0.05)。HIFU组治疗后血清β-hCG恢复正常时间长于UAE组(P<0.05)。HIFU组所有患者均恢复正常月经,UAE组57例(93.44%)恢复月经,但有9例出现月经失调,3例出现宫腔粘连。HIFU组再次妊娠成功率(100.00%)明显高于UAE组(28.57%,P<0.05)。结论 HIFU消融和UAE均能有效治疗CSP,但HIFU消融术在安全性、经济性、远期不良反应和保留生育能力方面均优于UAE,HIFU消融术更适用于有再次妊娠需求CSP者。

Objective To compare the efficacy and safety of high intensity focused ultrasound(HIFU)assisting suction curettage therapy with that of uterine artery embolization(UAE)assisting suction curettage therapy in the treatment of cesarean scar pregnancy(CSP).Methods A retrospective analysis was performed in 116 patients diagnosed with CSP and treated in our department from October 2015 to October 2017.Among them,55 patients were treated with HIFU(HIFU group)assisting suction curettage therapy,and 61 patients were treated with UAE(UAE group)assisting suction curettage therapy.Results The amount of bleeding during suction curettage and hospitalization expenses in HIFU group were(18.74±7.21)mL and(5026.28±1683.81)yuan,respectively.The amount of bleeding during suction curettage and hospitalization expenses in UAE group were(106.07±23.28)mL and(12 482.07±3461.63)yuan,respectively.They were significantly lower in HIFU group than in UAE group(P<0.01).Lower abdominal pain and lumbosacral pain occurred in41 patients in HIFU group,significantly higher than in UAE group(13 cases),while the incidence of lower limb pain,vomiting and fever was lower in HIFU group than in UAE group.The vaginal bleeding time after suction curettage in HIFU group[(12.37±3.42)days]was significantly shorter than that in UAE group[(14.61±5.46)days,(P<0.05)].The recovery time of serum beta-hCG in HIFU group was longer than in UAE group(P<0.05).All patients in HIFU group resumed normal menstruation,while only 57(93.44%)in UAE group resumed normal menstruation,but 9 patients had menstrual disorders and 3 patients had uterine adhesions.Furthermore,the success rate of re-pregnancy in HIFU group(100.00%)was significantly higher than that in UAE group(28.57%,P<0.05).Conclusion HIFU ablation and UAE are both effective in the treatment of CSP.However,HIFU ablation is superior to UAE in terms of safety,economy,long-term adverse reactions and fertility retention.HIFU ablation is more suitable for CSP patients with the need of re-pregnancy.