高能聚焦超声联合超声引导下清宫术对剖宫产瘢痕妊娠患者月经恢复及再妊娠结局的影响

Effect of HIFU combined with ultrasound guided dilatation and curettage on menstrual recovery and repregnancy outcomes in CSP patients

目的探讨高能聚焦超声(high intensity focused ultrasound,HIFU)联合超声引导下清宫术治疗剖宫产瘢痕妊娠(caesarean scar pregnancy,CSP)的临床疗效及对患者月经恢复及再妊娠结局的影响。方法回顾性分析2013年1月至2016年10月廊坊市第四人民医院CSP患者126例的临床资料,按照患者自愿原则分为两组,采用HIFU病灶消融联合超声引导下清宫术治疗为HIFU组(80例),采用子宫动脉化疗栓塞术(uterine artery chemoembolization,UACE)预处理后超声引导下清宫术治疗为UACE组(46例)。比较两组出血量、β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-hCG)转阴率、住院费用、住院天数、治疗有效率,随访两组月经恢复正常率、β-hCG转阴率、并发症、输卵管通畅率、再妊娠结局。结果①HIFU组清宫术中出血量<100 mL病例比例高于UACE组,住院费用低于UACE组,差异均有统计学意义(P<0.05);两组术后2周β-hCG转阴率、住院天数、治疗有效率比较差异无统计学意义(P>0.05)。两组均无子宫切除病例。②术后2个月,HIFU组月经恢复正常率高于UACE组,差异有统计学意义(P<0.05),血β-hCG转阴率及并发症发生率差异无统计学意义(P>0.05)。两组均未发生血栓、肺栓塞等严重并发症。③HIFU组术后3个月输卵管通畅率、术后3年正常宫内妊娠率高于UACE组,差异均有统计学意义(P<0.05)。结论HIFU联合超声引导下清宫术与UACE联合超声引导下清宫术相比,治疗CSP的疗效相近,但术中出血量少、住院费用低,正常再妊娠率高。

Objective To investigate the clinical effect of high intensity focused ultrasound(HIFU)combined with ultrasoundguided dilatation and curettage(D&C)on cesarean scar pregnancy(CSP)and its effect on menstrual recovery and repregnancy outcomes.Methods A retrospective analysis was performed on 126 CSP patients in Fourth People’s Hospital of Langfang City from January 2013 to October 2016.According to the voluntary principle of the patients,they were divided into HIFU group(HIFU combined with ultrasound guided D&C was performed,80 cases)and uterine artery chemoembolization(UACE)group(ultrasound guided D&C after UACE pretreatment was performed,46 cases).Blood loss,negative conversion rate ofβ-hCG,hospitalization cost,length of stay and effective rate of treatment were compared between the two groups,and follow-ups were conducted for normal menstrual recovery rate,negative conversion rate ofβ-hCG,complications,fallopian tube patency rate and outcomes of repregnancy between the two groups.Results①The proportion with blood loss in D&C<100 mL in HIFU group was significantly higher than that in UACE group,and the hospitalization cost in HIFU group was significantly lower than that in UACE group,the differences were statistically significant(P<0.05).There were no significant differences in the negative conversion rate ofβ-hCG at 2 weeks after surgery,length of hospital stay and effective rate of treatment between the two groups(P>0.05).There were no cases of hysterectomy in either group.②2 months after the operation,the normal rate of menstrual recovery in the HIFU group was higher than that in the UACE group(P<0.05),and the negative conversion rate ofβ-hCG and the incidence of complications showed no statistical difference(P>0.05).No serious complications such as thrombus and pulmonary embolism occurred in the two groups.③The patency rate of the fallopian tube 3 months after the operation and the normal intrauterine pregnancy rate 3 years after the operation in the HIFU group were higher than those in the UACE group,and the differences were statistically significant(P<0.05).Conclusion HIFU combined with ultrasound-guided D&C had the similar therapeutic effect on CSP to UACE combined with ultrasound-guided D&C,but with less intraoperative blood loss,lower hospitalization costs and a higher rate of normal repregnancy.