高强度聚焦超声治疗输卵管妊娠临床应用研究

High intensity focused ultrasound for the treatment of tubal pregnancy: a clinical trial

目的 探讨高强度聚焦超声（high intensity focused ultrasound，HIFU）治疗输卵管妊娠的可行性与临床疗效。方法 根据病史、体征并结合超声、血清β-人绒毛膜促性腺激素（β-hCG）临床检查结果诊断的输卵管妊娠患者16例，并排除输卵管孕部破裂或流产，无明显腹腔出血，无紧急手术指征。在超声定位下对输卵管孕部予以HIFU照射治疗。治疗第3、5、7、14、21天复查血清β-hCG，术后随访3-6个月。结果 16例患者接受HIFU治疗19次。随访14例中12例患者临床治愈：治疗前患者血清β-hCG为739-4600U/L，均在治疗20d内达正常水平（〈10U/L）；其中3例第1次复查β-hCG稍升高或不降，患者症状体征无明显变化，进行第2次HIFU治疗后效果满意。2例HIFU治疗失败，治疗前血清β-hCG分别高达7200U/L、9000U/L，HIFU治疗后血清β-hCG持续升高，并出现内出血症状，转手术治疗。2例失访。随访中，超声复查发现，包块存留但明显缩小；1例患者HIFU治疗3个月后再次发生同侧输卵管妊娠，手术切除。结论 HIFU治疗输卵管妊娠取得了较好的临床效果。仍有一些问题有待于进一步探讨，如治疗前血清β-hCG水平与HIFU疗效关系，HIFU治疗参数的个体化设置和调整能否提高疗效，HIFU治疗后输卵管粘连、包块与冉发的关系等。

Objective To evaluate the feasibility and efficacy of high intensity focused ultrasound （HIFU） therapy for the treatment of tubal pregnancy. Methods The present series consisted of 16 women with tubal pregnancy, diagnosed on clinical history, the findings of physical examination, ultrasound and serum β-hCG test, without any signs of tubal rupture or abortion, and there were no indications （ e. g. abdominal massive hemorrhage） of emergency operation. HIFU was irradiated at the adnexal mass or embryonic cyst guided by ultrasound, hCG test was repeated 3, 5, 7, 14 and 21 d after the procedure. Follow-up ranged from 3 to 6 months. Results Nineteen procedures of HIFU were performed in 16 cases, and follow-up was available in 14 cases, among them clinical cure was achieved in 12 cases. Two cases were lost to follow-up. In the successful cases, the hCG level dropped from 739 -4600 U/L to normal （ 〈 10 U/L） within 20 d after treatment. In 3 of the 12 cases who failed to respond to the first dose of HIFU therapy, with slight increase in hCG level but no worsening of the physical signs, HIFU was repeated and their results were satisfactory. Two failures in this series with hCG level as high as 7200 and 9000 U/L respectively, were subjected to ectopotomy due to internal bleeding. Those cases received follow-up with ultrasound showing that the residual masses in the involved adnexal area were evidently reduced in size; however, 3 months after the HIFU therapy, ectopic pregnancy recurred in 1 patient in the same side of adnexa area, who was then subjected to excision of the involved tube. Conclusions HIFU as a conservative treatment of tubal pregnancy, can produce certain satisfactory effects. However, there are still some problems to be clarified, such as the relationship between the hCG level and the efficacy of HIFU, long-term outcomes of the development of adhesion and fibrotic mass following the irradiation, and the individualized doses of HIFU parameters for improvement of efficacy.