高强度聚焦超声辅助腹腔镜下妊娠病灶清除术治疗Ⅲ型剖宫产瘢痕妊娠的临床效果及对患者再生育的影响

Clinical Effect of High-intensity Focused Ultrasound-assisted Laparoscopic Removal of Pregnancy Lesions in the Treatment of Type Ⅲ Cesarean Scar Pregnancy and Its Impact on Patients’Reproduction

目的:探讨高强度聚焦超声(HIFU)辅助腹腔镜下妊娠病灶清除术治疗Ⅲ型剖宫产瘢痕妊娠(CSP)的临床效果及对患者再生育的影响。方法:选择2017年6月-2018年12月江西省妇幼保健院妇科收治的有再生育要求的Ⅲ型CSP患者120例。根据患者知情原则随机分HIFU组、子宫动脉栓塞术(UAE)组、对照组,所有患者治疗后均随访24个月,10例失访。HIFU组(n=36)采用HIFU辅助腹腔镜下妊娠物清除+瘢痕修补术,UAE组(n=38)采用UAE辅助腹腔镜下妊娠物清除+瘢痕修补术,对照组(n=36)直接行腹腔镜下妊娠物清除+瘢痕修补术。比较三组手术时间、术中失血量、住院时间、术后高温率、术后疼痛视觉模拟评分法(VAS)评分、住院费用、术后第1天人绒毛膜促性腺激素(β-hCG)下降百分比、血β-hCG恢复正常时间、月经恢复时间及再次妊娠情况。结果:三组手术时间、术中失血量、术后VAS评分、住院费用、住院时间比较,差异均有统计学意义(P<0.05);HIFU组与UAE组手术时间均短于对照组(P<0.05);HIFU组术中失血量少于UAE组与对照组,且UAE组少于对照组,差异均有统计学意义(P<0.05);HIFU组术后VAS评分及住院费用均低于UAE组,HIFU组和UAE组均高于对照组,差异均有统计学意义(P<0.05)。三组住院时间比较,差异有统计学意义(P<0.05)。术后24个月随访三组妊娠情况,三组再次妊娠率及间隔时间比较,差异均有统计学意义(P<0.05),且HIFU组与对照组均优于UAE组(P<0.05)。结论:HIFU及UAE辅助腹腔镜下妊娠病灶清除术较直接手术治疗Ⅲ型CSP手术时间更短、术中出血量更少,但HIFU辅助腹腔镜下妊娠病灶清除术在经济性方面优于UAE,且其对Ⅲ型CSP患者后续妊娠结局并无不良影响,具有更高的临床应用价值。

Objective:To investigate the clinical effect of high-intensity focused ultrasound(HIFU)-assisted laparoscopic removal of pregnancy lesions in the treatment of type Ⅲ cesarean scar pregnancy(CSP)and its impact on patient reproductive.Method:From June 2017 to December 2018,120 cases of type Ⅲ CSP patients with reproductive requirements who admitted to the Department of Gynecology in Jiangxi Maternal and Child Health Hospital were collected.The patients were randomly divided into HIFU group,uterine artery embolization(UAE)group and the control group according to the patient informed principle,all patients were followed up for 24 months after treatment,10 cases were lost to follow-up.HIFU group(n=36)was given HIFU-assisted laparoscopic gestation removal and scar repair,UAE group(n=38)was given UAE-assisted laparoscopic gestation removal and scar repair,and the control group(n=36)was given laparoscopic gestation removal and scar repair.The operation time,intraoperative blood loss,hospitalization time,postoperative high temperature rate,postoperative pain visual analogue scale(VAS)score,hospitalization expenses,percentage of β-hCG decrease on the first day after surgery,and time of β-hCG return to normal,menstrual recovery time and repeated pregnancy were compared among three groups.Result:There were statistically significant differences in operative time,intraoperative blood loss,postoperative VAS score,hospitalization cost and length of stay among three groups(P<0.05);the operation times of HIFU group and UAE group were shorter than that of the control group(P<0.05);the intraoperative blood loss in HIFU group was less than those in UAE group and the control group,and UAE group was less than that in the control group,the differences were statistically significant(P<0.05);the postoperative VAS score and hospitalization cost in HIFU group were lower than those in UAE group,and HIFU group and UAE group were higher than those in the control group,the differences were statistically significant(P<0.05).There was significant difference in hospital stay among three groups(P<0.05).The pregnancies of three groups were followed up 24 months after operation,there were significant differences in the rate and interval of second pregnancy among three groups(P<0.05),HIFU group and the control group were better than those of UAE group(P<0.05).Conclusion:Compared with direct surgical treatment for type Ⅲ CSP,HIFU and UAE-assisted laparoscopic removal of pregnancy lesion has shorter operative time and less intraoperative blood loss,but HIFU-assisted laparoscopic removal of pregnancy lesions is superior to UAE in terms of economy,and has no adverse effect on the subsequent pregnancy outcome of patients with type Ⅲ CSP and higher clinical application value.