高强度聚焦超声联合清宫术与阴式手术治疗Ⅱ型子宫瘢痕妊娠的临床疗效比较

HIFU combined with curettage versus transvaginal surgery for patients with type Ⅱ cesarean scar pregnancy

目的比较高强度聚焦超声(high-intensity focused ultrasound,HIFU)联合清宫术与阴式手术治疗Ⅱ型子宫瘢痕妊娠的临床疗效,为临床选择最适宜治疗方式提供参考。方法选取2017年1月-2019年1月内江市第一人民医院收治的83例Ⅱ型子宫瘢痕妊娠患者,其中经HIFU联合清宫术治疗39例(HIFU组),经阴式手术治疗44例(阴式组),两组患者一般资料差异无统计学意义。比较两组手术出血量、手术时间、术后β-HCG值的下降率、住院时间、月经恢复时间、术中术后不良反应。结果两组患者均安全顺利完成治疗,两组术后β-HCG值的下降率及月经恢复时间无统计学差异(P>0.05);HIFU组与阴式组比较手术出血量[(23.33±19.41)ml vs(64.32±125.88)ml]、手术时间[(20.26±14.00)min vs(57.27±17.47)min]及住院时间[(10.51±3.85)d vs(5.80±1.84)d]差异均有统计学意义(P均<0.05)。结论HIFU联合清宫术及阴式手术均为治疗Ⅱ型子宫瘢痕妊娠的有效、安全方式,治疗效果无明显差异;但阴式手术术中出血量相对更多,手术时间相对更长;HIFU治疗患者住院时间相对更长。

Objective To compare the clinical effect of high-intensity focused ultrasound(HIFU)combined with curettage versus transvaginal surgery for patients with typeⅡscar pregnancy,and provide evidences for selection of appropriate treatment.Methods Totally 83 patients with typeⅡuterine scar pregnancy admitted to the First People’s Hospital of Neijiang from January 2017 to January 2019 were selected,of which 39 cases(HIFU group)were treated with HIFU combined curettage and 44 cases(transvaginal group)were treated with transvaginal surgery.There was no statistically significant difference in the general data of the two groups.The volume of intraoperative bleeding,operating time,postoperative decrease inβ-HCG level,length of hospital stay,time to menstrual recovery,and intraoperative and postoperative adverse reactions were compared between the two groups.Results Allpatients had completed the treatment successfully.There was no significant difference between the two groups in the decline ofβ-HCG value and time of menstrual recovery(all P>0.05).The intraoperative bleeding(23.33±19.41 ml vs 64.32±125.88 ml),operating time(20.26±14.00 min vs 57.27±17.47 min)and length of hospital stay(10.51±3.85 d vs 5.80±1.84 d)in the two groups were all significantly different(all P<0.05)between the HIFU group and the transvaginal group.Conclusion Both HIFU combined with curettage and transvaginal surgery are effective and safe for treatment of typeⅡuterine scar pregnancy,and there is no significant difference in the therapeutic effect between the two methods.However,the blood loss and the operating time is relatively greater in the transvaginal surgery group,while patients treated with HIFU have a longer hospital stay.