早期Ⅱ型、Ⅲ型剖宫产术后子宫瘢痕妊娠治疗方法分析

Analysis on the treatment of early type II and III cesarean section scar pregnancy

目的:本研究纳入剖宫产术后子宫瘢痕妊娠(CSP)患者共125例,分别给予超声监视下清宫术和高强超声聚焦治疗联合超声监视下清宫术治疗,探讨分析两种治疗方法的有效性及安全性。方法:纳入孕龄≤8周的符合标准的早期Ⅱ型、Ⅲ型CSP,并分为对照组和观察组,记录监测各项指标,术后3月行宫腔镜检查。结果:对照组和观察组治疗成功率分别为97.14%(68/70)、92.73%(51/55);住院时间、住院费用观察组高于对照组(P<0.01),术后阴道流血时间无统计学差异(P>0.05),术中出血量有统计学差异,观察组少于对照组,术后血β-HCG下降速度观察组快于对照组(P<0.05);术后3月宫腔镜检查见子宫下段均有子宫憩室存在,且憩室内有子宫内膜覆盖;所有患者均未发生子宫破裂或穿孔、邻近器官损伤、宫腔黏连等并发症。结论:HIFU治疗联合超声监视下吸宫治疗早期Ⅱ型、Ⅲ型CSP安全、有效且更符合微创原则,可作为早期CSP治疗方案;Ⅱ型、Ⅲ型CSP仍然是宫腔内妊娠,其发生可能与子宫憩室内子宫内膜有关。

Objective:In this study,a total of 125 patients with cesarean scar pregnancy(CSP)were included.They were treated negative pressure suction under ultrasound monitoring and high-intensity ultrasound focusing combined with negative pressure suction under ultrasound monitoring.The effectiveness and safety of the two treatment methods were compared.Method:Patients that age≤8 weeks and with early typeⅡand typeⅢCSP were included and divided into control group and observation group.The detection indexes were recorded and hysteroscopy was performed 3 months after operation.Results:The treatment success rate of the control group and the observation group were 97.14%(68/70)and 92.73%(51/55),respectively.The hospitalization time and hospitalization expenses of the observation group were higher than those of the control group(P<0.01),and there were no significant differences in postoperative vaginal bleeding time(P>0.05),the amount of bleeding during operation was statistically different,and the observation group was less than the control group.Postoperative bloodβ-HCG decreased faster in the observation group than in the control group(P<0.05).Three months after surgery,hysteroscopy showed that there were uterine diverticulum in the lower uterine segment,and the diverticulum was covered with endometrium.No complications such as uterine rupture or perforation,adjacent organ injury,and intrauterine adhesion occurred in all patients.Conclusion:HIFU treatment combined with negative pressure suction under ultrasound monitoring is safe and effective in the treatment of early typeⅡand typeⅢCSP.This method is also more in line with the principle of minimally invasive and can be used as an early CSP treatment plan.TypeⅡand typeⅢCSP are still intrauterine pregnancy,which may be related to the endometrium in the uterine diverticulum。