摘要
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.
出处
《中国医学计算机成像杂志》
CSCD
北大核心
2017年第3期279-282,共4页
Chinese Computed Medical Imaging