磁共振成像引导下高强度聚焦超声治疗剖宫产瘢痕妊娠的概述

Overview of magnetic resonance imaging guided focused ultra soundin the treatment of cesarean scar pregnancy

随着三孩政策的开放,我国剖宫产率呈逐渐上升趋势,剖宫产瘢痕妊娠(CSP)发生率也随之呈逐年升高,而对于如何治疗CSP,防止子宫出血破裂,目前国内外均无统一的治疗规范,而现如今需要一种无创、安全的治疗方案。磁共振成像引导下高强度聚焦超声,是通过超声的声窗发出高强度聚焦超声束穿透腹壁,作用于特定的组织,引发热效应、高压效应、机械效应、空化效应从而导致组织坏死纤维化,而对于正常组织无任何损害,是一种完全、无创的治疗方式。磁共振成像则是用来掌握和控制治疗的全过程,包括病变组织的定位、涉及的范围、治疗过程中组织的实时温度、治疗范围和治疗后疗效的评估,立体观察妊娠组织和子宫肌层的关系,以及妊娠组织与膀胱之间的距离。从而可以显示子宫瘢痕组织的厚度,并可将孕囊内的具体结构清楚显示,当孕囊种植时可准确判断出剖宫产瘢痕与孕囊之间的关系、肌层的厚度、孕囊大小与孕囊植入瘢痕及子宫肌层的范围和深度等状况。故本文就磁共振成像引导下高强度聚焦超声治疗剖宫产瘢痕妊娠进行概述。

With the opening of the three-child policy,the cesarean section rate in China is gradually increasing,and the incidence of CSP is increasing year by year,and there is currently no unified treatment standard at home and abroad for how to treat CSP and prevent uterine bleeding rupture,and now we need a non-invasive and safe treatment plan.The high-intensity focused ultrasound guided by magnetic resonance is to emit a high-intensity focused ultrasonic beam through the sound window of ultrasound to penetrate the abdominal wall,acting on specific tissues,causing thermal effects,high pressure effects,mechanical effects,cavitation effects leading to tissue necroticfibrosis,and there is no damage to normal tissues,it is a completely non-invasive treatment method.Magnetic resonance imaging is used to grasp and control the whole process of treatment,including the positioning of the lesion tissue,the scope involved,the real-time temperature of the tissue during the treatment,the evaluation of the treatment range and the efficacy after treatment,the three-dimensional observation of the relationship between the pregnancy tissue and the myometrium,and the distance between the pregnancy tissue and the bladder.So that the thickness of the uterine scar tissue can be displayed,and the specific structure in the gestational sac can be clearly displayed,and the relationship between the cesarean scar and the gestational sac,the thickness of the muscular layer,the size of the gestational sac,and the extent and depth of the cesarean implanted scar and the myometrium of the uterus can be accurately judged when the gestational sac is implanted.Therefore,this article gives an overview of magnetic resonance imaging-guided high-intensity focused ultrasound in the treatment of caesarean section scar pregnancy.