高强度超声聚焦联合宫腔镜终止剖宫产术后子宫瘢痕妊娠的疗效与安全性

Management of Cesarean Scar Pregnancy by HIFU Combined with Suction Curettage under Hysteroscopic Guidance

目的:探讨宫腔镜联合高强度超声聚焦(HIFU)终止剖宫产术后子宫瘢痕妊娠(CSP)的疗效和安全性。方法:回顾性分析2016年1月至2016年6月嘉兴市妇幼保健院收治的30例CSP病例资料,先行高强度超声聚焦治疗,治疗后2~3天再行宫腔镜手术,观察分析孕龄、术前血β-HCG水平、子宫峡部肌层厚度、病灶形态、手术成功率、治愈率、手术时间、术中出血量、术后阴道流血持续时间、血β-HCG恢复正常时间以及并发症等。结果:30例患者中位孕龄为45d(38~70d),术前中位血β-HCG为15000U/L(2694~161863U/L),子宫峡部肌层厚度平均为2.1mm(1.6~3.5mm)。30例中28例宫腔镜下见子宫峡部凹陷呈腔隙状,所有病例妊娠物均突向宫腔或峡部腔隙内,采用宫腔镜电切割环联合刮宫清除妊娠物。平均手术时间为(22±10)min,术中出血量(65±60)ml,手术成功率、治愈率均为100%(15/15),血β-HCG术后平均(23±10)d恢复正常,术后阴道流血持续时间平均(21±12)d消失。无一例并发症发生。结论:宫腔镜联合HIFU终止CSP安全、有效。

Purpose： To investigate the safety and efficacy of high-intensity focused ultrasound （HIFU） combined with hysteroscopy in treatment of cesarean scar pregnancy （CSP）. Methods： From Jan. 2016 to Jun. 2016, 30 cases with CSP treated by HIFU combined with suction curettage under hysteroscopic guidance were studied retrospectively in Maternity ＆ Child Health Hospital Municipal Sanyi Hospital. The clinical characteristics including gestational age, myometrial thickness anterior to the CSP, 15-HCG level before treatment, successive rate, curative rate, operative time, blood loss, duration of β-HCG recovered to normal and vaginal bleeding, and complications were collected and analyzed. Results： Median gestational age was 45 days （range, 38 - 70 days）. Median level of β-HCG before treatment was 15000U/L （range, 2694 -161863U/L）. Mean thickness of anterior myometrium was 2.1mm. Twenty-eight cases underwent uterine artery embolism （UAE） before hysteroscopy. Pouch in the anterior uterine isthmus with gestation masses implanted were observed in 14 cases （93.3%, 28/30）. CSP masses progressed toward the pouch or uterine cavity in all cases was removed by cutting wire loop electrode combined with curettage. The mean operative time was （22±10） minutes. The curative rate were 100%. No complication occurred in these cases. The mean duration of HCG recovery was （22±10） days. The mean time for vaginal bleeding was （21±12） days. Conclusion： Management of cesarean scar pregnancy by HIFU combined with suction curettage under hysteroscopic guidance is safe and effective.