高强度超声聚焦消融治疗剖宫产瘢痕部位妊娠的价值研究

Clinical value of high-intensity focused ultrasound ablation in treatment of cesarean scar pregnancy

目的研究高强度超声聚焦(HIFU)消融治疗剖宫产瘢痕部位妊娠(CSP)的临床价值。方法选取石家庄市第一医院2016至2018年诊治的120例CSP患者作为研究对象,采用前瞻性随机对照研究方法分为子宫动脉栓塞组(UAE组)、高强度超声聚焦组(HIFU组)和手术组,每组40例。HIFU组病例采用高强度超声聚焦消融联合宫腔镜手术清除病灶疗法,UAE组采用子宫动脉栓塞联合宫腔镜手术清除病灶疗法,手术组采用阴式瘢痕妊娠病灶切除+缝合修补术。比较3组病例基线资料、围术期和疗效指标。结果3组初次治疗成功率比较差异无统计学意义(P>0.05)。HIFU组和手术组的住院日均少于UAE组(P<0.05)。HIFU组治疗费用为3组中最少,手术组少于UAE组(P<0.05)。HIFU组疼痛等级评分为3组中最低,手术组少于UAE组(P<0.05)。3组治疗后阴道流血时间、HCG值降至正常时间和并发症发生率比较差异无统计学意义(P>0.05)。HIFU组和手术组的月经恢复情况均好于UAE组,差异有统计学意义(P<0.05)。结论HIFU消融治疗CSP创伤最小,同时患者平均住院日最少、治疗费用最低,并且疼痛评分最低;接受HIFU消融治疗的CSP患者月经恢复情况优于UAE治疗者。

Objective To investigate the clinical value of high-intensity focused ultrasound(HIFU)ablation in treatment of cesarean scar pregnancy(CSP).Methods A total of 120 CSP patients who were diagnosed and treated in our hospital from 2016 to 2018 were enrolled as research subjects,who were divided into uterine artery embolization group(UAE group,n=40),HIFU group(n=40)and surgery group(n=40)based on a prospective randomized controlled study.The patients in HIFU group were treated by HIFU ablation combined with lesion resection by hysteroscopy.The patients in UAE group were treated by UAE combined with lesion resection by hysteroscopy,and the patients in surgery group were treated by transvaginal local lesion resection and suture repairing operation.The baseline data,perioperative period and efficacy indexes were observed and compared among the three groups.Results There was no statistically significant difference in initial treatment success rate among the three groups(P>0.05).The hospitalization days in HIFU group and surgery group were significantly shorter than those in UAE group(P<0.05).The treatment cost in HIFU group was the least among the three groups,which in surgery group was significantly less than that in UAE group(P<0.05).The pain rating scores in HIFU group were the lowest among the three groups,and the scores in surgery group were significantly lower than those in UAE group(P<0.05).There were no significant differences in duration of vaginal bleeding,the time of HCG value decreasing to normal time and the incidence rate of complications among three groups(P>0.05).The menstrual recovery status in HIFU group and surgery group was superiot to that in UAE group(P<0.05).Conclusion In the treatment of CSP,HIFU ablation treatment has the least trauma,meanwhile,the patients have the shortest hospital stay on average,the lowest treatment costs,and the lowest pain rating scores.In addition,the patients with CSP who receive HIFU ablation treatment have better menstrual recovery,as compared with those by UAE treatment.