超声动态评估子宫动脉栓塞后清宫治疗瘢痕妊娠预后的临床价值

Evaluation of prognostic value of cesarean section scar pregnancy after uterine arterial chemoembolization with cesarean section by ultrasonography

目的探讨超声在评估子宫动脉栓塞术(UAE)后清宫治疗剖宫产瘢痕妊娠(CSP)预后的临床应用价值。方法对2015年1月至2018年6月在哈尔滨医科大学附属第二医院进行UAE治疗后24~48 h内经超声引导行清宫术的42例瘢痕妊娠患者进行回顾性分析,对UAE前的超声特征进行超声评分以及分型,评估各组患者术中及术后并发症情况,治疗后血清β-hCG下降情况,超声随访术后是否形成血肿及血肿吸收时间。结果患者均一次栓塞成功,瘢痕妊娠治疗后均成功保留子宫。超声评分3分组18例,4分组24例;超声分型Ⅰ型2例,Ⅱ型25例,Ⅲ型15例。超声评分3分组与4分组间术中并发症、术后包块形成及吸收时间比较差异有统计学意义(P<0.05)。不同超声分型术中并发症、术后并发症、术后包块形成情况及人绒毛膜促性腺激素(β-hCG)下降情况组间比较差异均无统计学意义(P>0.05)。结论超声对UAE后清宫术治疗CSP的预后评估具有临床应用价值,超声评分能够评估其治疗疗效并为CSP的诊治提供更多的参考信息。

Objective To assess the clinical value of uterine curettage ultrasound in the evaluation of cesarean section scar pregnancy(CSP)after uterine arterial chemoembolization(UAE).Methods Retrospective analysis were performed in 42 patients who took uterine curettage within 24-48 hours after UAE treatment in the Second Affiliated Hospital of Harbin Medical University from January 2015 to June 2018.The ultrasonic manifestations were graded and classified before UAE.The intraoperative and postoperative complications,time ofβ-human chorionic gonadotrophin declined to normal limits were evaluated,and the formation of hematoma and hematoma absorption time were followed up by ultrasound.Results UAE was performed successfully in all patients.The ultrasound-guided scar pregnancy was successfully completed.The uterus was successfully retained in all patients.Among the 42 patients,18 cases were 3 scores group,and 24 cases were 4 scores group according to the ultrasonic scoring system.Two cases were typeⅠgroup,25 cases were typeⅡgroup,and 15 cases were typeⅢgroup according to the ultrasonic classification.The amount of intraoperative complications,postoperative mass formation and absorption time were significantly different between 3 scores group and 4 scores group(P<0.05).No significant differences were found in intraoperative complications,postoperative complications,postoperative mass formation andβ-human chorionic gonadotropin(β-hCG)value among different ultrasonic classification groups(P>0.05).Conclusions Ultrasonography has clinical application value in evaluating the prognosis of CSP treated with UAE.Ultrasonic scoring system can evaluate the efficacy and is helpful for predicting clinical outcome of CSP.