高强度聚焦超声联合宫腔镜手术治疗内生型切口 妊娠的疗效分析

Efficacy analysis of high-intensity focused ultrasound(HIFU)combined with hysteroscopy in the treatment of endogenous incision pregnancy

目的评价高强度聚焦超声(high intensity focused ultrasound,HIFU)联合宫腔镜手术治疗内生型切口妊娠(cesarean scar pregnancy,CSP)的疗效,并与子宫动脉栓塞术(uterine arterial embolization,UAE)联合宫腔镜手术治疗进行对比分析。方法选取2017年1月至2019年12月内江市妇幼保健院收治的60例内生型CSP患者,按照就诊顺序分组,单号为HIFU联合宫腔镜手术组(HIFU组),双号为UAE联合宫腔镜手术组(UAE组),各30例,比较两组间术中出血量、进水量以及并发症的发生率,并随访血人绒毛膜促性腺激素(human choionic gonadotophin,hCG)恢复正常时间及月经复潮情况。结果两组均未发生子宫大出血、子宫穿孔、水中毒及宫内残留,术后血hCG于2~3周恢复正常,月经于1月左右复潮,其中UAE组术后月经量较平素月经量明显减少、色黑伴下腹痛,而HIFU组与平素月经相当;宫腔镜术中HIFU组出血量与进水量(67.7±88.0)mL、(128.7±89.4)mL均多于UAE组(35.8±55.3)mL、(70.7±46.8)mL,前者差异无统计学意义(P>0.05),后者差异有统计学意义(P<0.05)。结论①HIFU联合宫腔镜手术治疗内生型CSP疗效好,能彻底清除病灶,预防子宫大出血、避免子宫切除,保留患者生育功能;②相比于UAE,HIFU无卵巢功能及内膜损伤,月经恢复好,患者痛苦小,更易于接受;③HIFU联合宫腔镜术中出血量及进水量相对更多,需有经验的宫腔镜医师进行操作,必要时需宫腔球囊压迫止血。

Objective To evaluate the efficacy of high intensity focused ultrasound(HIFU)combined with hysteroscopy in the treatment of endogenous incisional pregnancy and to compare it with UAE combined with hysteroscopic surgery. Methods 60 cases of endogenous incisional pregnancy patients admitted to Neijiang Maternal and Child Health Care Hospital from January 2017 to December2019 were grouped according to the treatment order. The single number was HIFU combined hysteroscopic surgery group(HIFU group),and the double number was UAE combined hysteroscopic surgery group(UAE group),with 30 cases each,comparing the differences between the two groups in intraoperative blood loss,water inflow,the incidence of complications,the normal recovery time of blood h CG,and the return of menstruation. Results There was no risk of uterine hemorrhage,uterine perforation,water poisoning or intrauterine residual in the two groups. Postoperative blood h CG returned to normal in 2;3 weeks,and menstruation returned to normal in about one month. During hysteroscopy,the amount of blood loss and water intake in the HIFU group(67. 7 ± 88. 0)m L and(128. 7 ± 89. 4)m L were higher than those in the UAE group(35. 8 ± 55. 3)m L and(70. 7 ± 46. 8)m L,with no statistical significance in the former(P > 0. 05)and statistical significance in the latter(P < 0. 05). Conclusion(1)HIFU combined with hysteroscopy in the treatment of endogenous incision pregnancy has a good effect,which can completely clear the lesion,prevent massive uterine bleeding,avoid hysterectomy,and preserve the fertility of the patient.(2)Compared with intervention,HIFU has no ovarian function and intima damage,menstrual recovery is good,patients suffer less pain,and it is more acceptable.(3)HIFU combined with hysteroscopy has a relatively higher blood volume and water intake,which should be operated by an experienced hysteroscopic physician. If necessary,uterine balloon compression is needed to stop bleeding.