高强度聚焦超声辅助宫腔镜定位电切术治疗Ⅱ型剖宫产瘢痕部位妊娠的疗效分析

Efficacy of high-intensity focused ultrasoundcombined with hysteroscopy positioning elec⁃trotomy in the treatment of type II caesarean scar pregnancy

目的:探讨高强度聚焦超声(HIFU)辅助宫腔镜定位电切术治疗Ⅱ型剖宫产瘢痕部位妊娠(CSP)的疗效、治疗参数及影响因素。方法:将90例Ⅱ型CSP患者依照自愿原则分为HF组(54例)与对照组(36例)。根据妊娠囊直径,将HF组分为A组(最大直径10~19 mm)、B组(最大直径20~29 mm)、C组(最大直径30~39 mm)。对照组行宫腔镜定位电切术,HF组在HIFU消融后行宫腔镜定位电切术。比较HF组与对照组临床疗效指标、术后并发症及术后CSP复发率、再妊娠结局。分析术后CSP复发的影响因素及HIFU治疗CSP的参数及不良反应。结果:HF组术中出血量少于对照组,β-人绒毛膜促性腺激素(β-HCG)降至正常时间、月经恢复正常时间短于对照组(P<0.05)。HF组术后并发症发生率、术后1年CSP复发率明显低于对照组(P<0.05),正常宫内妊娠率高于对照组(P<0.05)。孕囊直径、术中出血量、瘢痕处子宫壁厚度、术前β-HCG水平为术后CSP复发的危险因素,HIFU预处理为术后CSP复发的保护性因素(P<0.05)。B组和C组治疗时间长于A组、强度高于A组、剂量大于A组(P<0.05),C组治疗时间长于B组、强度高于B组、剂量大于B组(P<0.05),C组治疗区域疼痛比例高于A组和B组(P<0.05)。结论:HIFU辅助宫腔镜定位电切术治疗Ⅱ型CSP的疗效更佳。对于妊娠囊较大的CSP病例,需要更高的HIFU治疗参数。

Objective:To investigate the efficacy and treatment parameters of high-intensity focused ultrasound(HIFU)combined with hysteroscopy positioning electrotomy in the treatment of typeⅡcaesarean scar pregnancy(CSP).Methods:A total of 90 patients with typeⅡCSP were divided into HF group(54 cases)and control group(36 cases)on a voluntary basis.According to the diameter of pregnancy capsule,HF group was divided into Group A(10-19mm),Group B(20-29mm),group C(30-39mm).The patients in the control group received hysteroscopy positioning electrotomy,and those in HF group received hysteroscopy positioning electrotomy after HIFU.The clinical efficacy,postoperative complications,postoperative CSP recurrence rate and secondary pregnancy outcome were compared.The influencing factors of postoperative recurrence of CSP,the parameters and adverse reactions of HIFU treatment of CSP were investigated.Results:The amount of intraoperative blood loss,the time ofβ-HCG to normal and menstruation to normal,the incidence of postoperative complications and the recurrence rate of CSP 1-year post-surgery in HF group were lower than those in control group,while the normal intrauterine pregnancy rate was higher than that in control group(P<0.05).Diameter of pregnancy sac,intraoperative blood loss,thickness of the uterine wall at scar,and preoperative HCG level were the risk factors for postoperative CSP recurrence.HIFU was the protective factor for postoperative CSP recurrence(P<0.05).The treatment time,intensity and dose of group B and group C were higher than those ingroup A(P<0.05),the treatment time,intensity and dose of group C were higher than those ingroup B(P<0.05),and the pain proportion in the treatment area of group C was higher than that of group A and Group B(P<0.05).Conclusion:HIFU assisted hysteroscopic electroresection is effective in the treatment ofⅡtype CSP.For CSP cases with large gestational pouch,higher HIFU treatment parameters are required.