子宫动脉栓塞介入与高强度聚焦超声治疗子宫瘢痕妊娠后再妊娠结局比较

Comparative analysis of outcomes of subseguent pregnancy of uterine artery embolization intervention and high-intensity focused ultrasound for treating women with uterine scar pregnancy

目的:分析子宫动脉栓塞介入(UAE)与高强度聚焦超声(HIFU)治疗子宫瘢痕异位妊娠(CSP)后再次妊娠结局情况。方法:对2016年1月-2016年12月在本院确诊为子宫瘢痕异位妊娠择期行UAE(n=190)或HIFU(n=197)预处理治疗的387例患者进行4年随访,比较两种不同方式处理CSP后再次妊娠情况。结果:随访结束时UAE组190例中有9例失访,181例纳入研究;HIFU组中197例有13例失访,184例纳入研究。再次妊娠率UAE组(65.8%)与HIFU组(67.4%)无差异,足月分娩、流产及其他异位妊娠比例两组无差异(P>0.05);UAE组发生早产(19.3%)、再次CSP(13.4%)、前置胎盘/胎盘植入(13.4%)、围产期合并症(16.0%)高于HIFU组(8.9%、2.4%、3.2%、7.3%)(P<0.05)。结论:UAE与HIFU治疗CSP后均可获得较好的再妊娠率,但HIFU在降低再次妊娠时子宫瘢痕妊娠、胎盘异常、早产率及围产期合并症等方面优于UAE。

Objective:To comparative analyze the outcomes of subseguent pregnancy of uterine artery embolization(UAE)and high-intensity focused ultrasound(HIFU)for treating women with uterine scar pregnancy(USEP).Methods:387 women with USEP from January 2016 to December 2016 were included and were divided group A(190 women who underwent UAE for pretreatment)and group B(197 women who underwent HIFU for pretreatment).All of these women were followed up for 4 years.The situation of re-pregnancy of the women was compared between the two groups.Results:At the end of follow-up,9 of 190 women in group A were lost to follow-up and 181 women were included for analysis.13 of 197 women in group B were lost to follow-up and 184women were included for analysis.There was no significant difference in the rate of re-pregnancy(65.8%vs.67.4%)of the women between the two groups,and there were no significant differences in the percentages of full-term delivery,abortion,and other ectopic pregnancy of the women between the two groups(P>0.05).The incidences of preterm birth(19.3%),recurrent of USEP(13.4%),placenta previa/placenta implantation(13.4%),and perinatal complications(16.0%)of the women in group A were significant higher than those(8.9%,2.4%,3.2%,and 7.3%)of the women in group B(P<0.05).Conclusion:UAE and HIFU for treating the women with USEP can all achieve better repregnancy result,but compared with those of UAE,HIFU has significantly better effect on reducing uterine scar pregnancy again,placental abnormalities,premature birth,and perinatal complications.