运用辅助检查评估高强度聚焦超声治疗剖宫产瘢痕妊娠的临床价值

Discussion on the clinical value of high intensity focused ultrasound in the treatment of cesarean section scar pregnancy with auxiliary examination

目的探讨运用磁共振(magnetic resonance imaging,MRI)、超声和血清人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)评估高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的疗效。方法选取2015年2月至2016年9月在成都市妇女儿童中心医院采用HIFU治疗的CSP患者14例,观察治疗前后患者hCG水平变化和影像图像改变。结果治疗后5 d,患者MRI扩散加权图像发生改变,表观弥散系数和治疗前比较差异有统计学意义(P<0.05),hCG与治疗前比较差异无统计学意义(P>0.05);治疗4周后,阴道彩超显示12例患者病灶完全消失,2例子宫切口见一不规则壁薄光滑的无回声区,hCG明显降低,与治疗前比较差异有统计学意义(P<0.05)。结论多种辅助检查结合能够早期准确评估HIFU治疗CSP的效果和预后,减轻患者经济负担,有较好的临床价值。

Objective To evaluate the efficacy and safety of high intensity focused ultrasound （HIFU） in the treatment of cesarean scar pregnancy （CSP） by using magnetic resonance imaging （ MRI）, ultrasound and serum human chorionic gonadotropin （hCG）. Methods 14 patients with CSP treated with HIFU from February 2015 to September 2016 in Chengdu Women and Children＇ s Central Hospital were selected to observe changes in hCG levels and image changes before and after treatment. Results After 5 days of treatment, the MRI diffusion - weighted images were changed, and the apparent diffusion coefficient was significantly different from that before treatment （ P 〈 0. 05 ）. There was no significant difference in hCG before and after treatment （ P 〉 0. 05 ） ; After 4 weeks of treatment, the vaginal color ultrasonography showed that the lesion in 12 patients completely disappeared, an irregular echo -free area with thin and smooth wall were seen in uterine incision of 2 cases. HCG significantly reduced, compared with before treatment the difference was statistically significant （P 〈 0. 05 ）. Conclusion A variety of auxiliary examination combined can be an early and accurate assessment of HIFU treatment of CSP effect and prognosis, thus reduce the economic burden of patients and are of good clinical value.