高强度聚焦超声联合甲氨蝶呤用于宫腔镜治疗子宫瘢痕妊娠预处理效果及远期再生育结局

Analysis of pretreatment effect of high intensity focused ultrasound combined with methotrexate before hysteroscopic treatment of uterine scar pregnancy and the outcome of sebsequent pregnancy of the women

目的:探究高强度聚焦超声(HIFU)联合甲氨蝶呤(MTX)预处理后行宫腔镜治疗子宫瘢痕妊娠的临床效果及再生育情况。方法:收集2015年1月—2016年12月在本院接受治疗且有再生育要求的114例子宫瘢痕妊娠患者,根据治疗方法分为对照组与观察组各57例。对照组采用HIFU预处理、观察组采用HIFU联合MTX预处理,两组均行宫腔镜清宫术治疗。电话术后随访3年,分析两组临床治疗效果及再生育情况。结果:术后2d两组血β-hGG水平均低于术前且观察组(28654.27±2234.51 U/L)低于对照组(32412.33±2758.64 U/L),观察组血β-hGG恢复正常时间(41.3±5.8d)、住院时间(6.5±2.8d)及月经恢复时间(35.2±5.8d)均低于对照组(均P<0.05)。随访3年,对照组治疗后宫内妊娠44.8%,流产25.4%,未孕13.4%,再次CSP7.5%,异位妊娠9.0%,宫内妊娠者中发生妊娠并发症36.7%;观察组宫内妊娠56.7%,流产19.4%,未孕10.5%,再次CSP6.0%,异位妊娠7.5%,宫内妊娠者中发生妊娠并发症23.7%。两组治疗后再生育情况无差异(P>0.05)。结论:HIFU联合MTX用于宫腔镜清宫术治疗子宫瘢痕妊娠预处理效果更佳,但对患者远期再生育结局无明显影响,临床可结合患者需求选择合适预处理方案。

Objective:To explore the clinical effect of women with uterine scar pregnancy treated by hysteroscopy treatment after high intensity focused ultrasound(HIFU)combined with methotrexate(MTX)for pretreatment and the reproduction situation of the women.Methods:114 women with uterine scar pregnancy were selected from January 2015 to December 2017.According to the treatment methods,these women were divided into control group and observation group(57 cases in each group).The women in the control group had received HIFU for pretreatment,and the women in the observation group had received HIFU combined with MTX for pretreatment,and then the women in both groups had received hysteroscopic curettage.The women in the two groups had been followed up by telephone for 5 years after operation.The clinical treatment effect and long-term reproduction of the women in the two groups were analyzed.Results:The serumβ-HCG level of the women in the two groups had decreased significantly after operation,and that of the women in the observation group(28654.27±2234.51 U/L)was significant lower than that(32412.33±2758.64 U/L)of the women in the control group,and the recovery time of serumβ-HCG level returned to normal(41.3±5.8 d),the hospital stay(6.5±2.8 d),and menstrual recovery time(35.2±5.8 d)of the women in the observation group were significant lower than those of the women in the control group(all P<0.05).After 3 years of followed up,the rates of intrauterine pregnancy,abortion,non-pregnancy,secondary CSP,ectopic gestation,and complications occurred in intrauterine pregnancy of the women in the control group were 44.8%,25.4%,13.4%,7.5%,9.0%,and 36.7%,respectively.After 3 years of followed up,the rates of intrauterine pregnancy,abortion,non-pregnancy,secondary CSP,ectopic gestation,and complications occurred in intrauterine pregnancy of the women in the observation group were 56.7%,19.4%,10.5%,6.0%,7.5%,and 23.7%,respectively.There was no significant difference in reproduction situation of the women after treatment between the two groups(P>0.05).Conclusion:HIFU combined with MTX for pretreatment before hysteroscopic curettage has better effectiveness compared with HIFU pretreatment alone,but both pretreatments has the same outcomes of subsequent pregnancy,so the appropriate pretreatment scheme can be selected according to the needs of women in clinical practice.