高强度超声聚焦与子宫动脉栓塞术联合宫腔镜下清宫术治疗剖宫产瘢痕部位妊娠的疗效对比

Clinical Analysis of High Intensity Focused Ultrasound or Uterine Artery Embolization Combined with Hysteroscope in the Treatment of Cesarean Scar Pregnancy

【目的】比较高强度超声聚焦(HIFU)与子宫动脉栓塞术(UAE)联合宫腔镜下清宫术治疗剖宫产瘢痕部位妊娠(CSP)的疗效。【方法】回顾性分析2018年6月至2019年12月在本院确诊的157例CSPⅡ型患者,其中82例在宫腔镜下清宫术前接受HIFU治疗(HIFU组),75例在宫腔镜下清宫术前接受UAE治疗(UAE组),比较两组临床疗效。【结果】UAE组术中出血量为(155.33±40.35)mL,明显少于HIFU组的(189.84±50.64)mL,差异有统计学意义(P<0.05);UAE组手术时间为(26.12±10.02)min,明显短于HIFU组的(32.33±14.57)min,差异有统计学意义(P<0.05);UAE组术后第一天血红蛋白(Hb)下降量为(5.53±6.47)g/L,明显少于HIFU组的(7.93±7.85)g/L,差异有统计学意义(P<0.05)。HIFU组经量减少患者占比(15.85%)明显少于UAE组(26.66%)(P<0.05);两组术后第3天β-HCG下降量、术后阴道流血时间、术中可见子宫憩室患者占比以及再次手术患者占比比较,差异均无统计学意义(P>0.05)。【结论】HIFU和UAE联合宫腔镜下清宫术均能有效治疗CSP,但UAE组术中出血量少,而HIFU组在保护生育功能方面优于UAE组。

【Objective】To compare the effect of high intensity focused ultrasound(HIFU)or uterine artery embolization(UAE)combined with hysteroscope in the treatment of typeⅡcesarean scar pregnancy(CSP).【Methods】A retrospective analysis was performed in 157 patients diagnosed with CSP(typeⅡ)and treated in our hospital from June 2018 to December 2019.Among them,82 patients were treated with HIFU combined with hysteroscope(the HIFU group)and 75 patients were treated with UAE combined with hysteroscope(the UAE group).Clinical efficacy was compared between the two groups.【Results】The amount of bleeding during the operation in the UAE group(155.33±40.35)mL is much less than that in the HIFU group(189.84±50.64)mL(P<0.05);The operation time of the UAE group(26.12±10.02)min was shorter than that in the HIFU group(32.33±14.57)min(P<0.05);The decrease of hemoglobin(Hb)on the first day after surgery in UAE group(5.53±6.47)g/L was less than that in the HIFU group(7.93±7.85)g/L(P<0.05).Follow-up the menstrual recovery,patients with hypomenorrhea in the HIFU group(15.85%)were significantly less than that in the UAE group(26.66%)(P<0.05).Compared to the decrease ofβ-HCG on the third day after operation,the time of vaginal bleeding after operation,the number of cases with uterine diverticulum during the operation and the number of cases undergo second operation,there were no statistically significant difference between the two groups(P>0.05).【Conclusion】Either HIFU or UAE combined with hysteroscope can effectively treat CSP.However,the UAE group is superior to HIFU group in reducing hemorrhage during operation and HIFU group is superior to UAE group in protecting reproductive function.