高强度聚焦超声联合术后清宫治疗胎盘植入的有效性研究

Study on the efficacy of high intensity focused ultrasound combined with postoperative uterine clearing in the treatment of placenta accreta

目的探讨高强度聚焦超声联合术后清宫治疗胎盘植入的有效性及对患者并发症的影响。方法选择2016年1月～2018年6月重庆医科大学附属大学城医院和重庆医科大学附属第一医院妇产科就诊的60例胎盘植入患者,按照随机数字表法分为对照组和观察组,每组各30例,对照组实施经子宫动脉甲氨蝶呤灌注栓塞联合清宫治疗,观察组实施高强度聚焦超声联合术后清宫治疗,比较两组的术中出血量、术后出血量、一次性清宫成功率、子宫切除率、术后并发症发生率、术后疼痛评分、血清人绒毛膜促性腺激素β(β-HCG)、住院时间、子宫复旧时间、月经恢复时间、免疫功能指标。结果两组一次性清宫成功率比较,差异无统计学意义(P> 0.05),但观察组的术中出血量和术后出血量均低于对照组(P <0.05),其子宫切除率、术后并发症总发生率、术后疼痛评分均低于对照组(P <0.05)。术后,观察组的血清β-HCG低于对照组(P <0.05),血清β-HCG恢复正常时间、住院时间、子宫复旧时间、月经恢复时间均短于对照组(P <0.05)。两组术后CD3^+、CD4^+/CD8^+等指标均较术前降低(P <0.05),而术后观察组的免疫功能各项指标均高于对照组(P <0.05)。结论高强度聚焦超声联合术后清宫治疗可在保证清宫效果的基础上,有效减少患者的出血量、并发症、子宫切除,有利于减轻其术后疼痛感和免疫功能异常,促使患者血清β-HCG、子宫、月经等尽快恢复。

Objective To study the effect of high intensity focused ultrasound (HIFU) combined with uterine clearing on placenta accreta and its complications. Methods From January 2016 to June 2018, in University City Hospital Affiliated to Chongqing Medical University and the First Hospital Affiliated to Chongqing Medical University, 60 patients with placenta accreta were selected, according to random number table method, they were divided into control group and observation group, with 30 cases in each group. The control group was treated with transuterine arterial methotrexate embolization combined with uterine clearing, and the observation group was treated with high intensity focused ultrasound combined with postoperative uterine clearing. The blood loss, postoperative blood loss and one-off uterine clearance success rate, the rate of hysterectomy, the incidence of postoperative complications, postoperative pain score, serum human chorionic gonadotropin β(β-HCG), hospitalization time, uterine recovery time, menstrual recovery time, immune function index in the two groups were compared. Results There was no significant difference in the success rate of one-off uterine clearing between the two groups (P > 0.05), but the amount of intraoperative and postoperative bleeding in the observation group was lower than that in the control group (P < 0.05). The hysterectomy rate and the total incidence of postoperative complications in the observation group were lower than those in the control group (P < 0.05). The postoperative pain score was lower than that in the control group (P < 0.05). After operation, the serum β-HCG in the observation group was lower than that in the control group (P < 0.05). The recovery time of serum β-HCG, hospitalization time, uterine recovery time and menstrual recovery time in the observation group were shorter than those in the control group (P < 0.05). The indexes of CD3+ and CD4+/CD8+ in the two groups were lower than those before operation (P < 0.05), but the immune function indexes in the observation group were higher than those in the control group (P < 0.05). Conclusion High intensity focused ultrasound combined with postoperative hysterectomy can effectively reduce the amount of bleeding, complications and hysterectomy of patients on the basis of ensuring the effect of hysterectomy, which is conducive to the reduction of postoperative pain and abnormal immune function, and the prompt recovery of serum betahcg, uterus and menstruation of patients.