高强度聚焦超声与药物保守治疗对剖宫产瘢痕部位妊娠的临床效果评价

Evaluation of the Clinical Effect of High-Intensity Focused Ultrasound and Drug Conservative on the Treatment of Cesarean Scar Pregnancy

目的:观察高强度聚焦超声(HIFU)与药物保守治疗对Ⅰ型、Ⅱ型剖宫产瘢痕部位妊娠(CSP)治疗的临床效果评价。方法:回顾性分析2018年1月至2021年12月在绵阳市中心医院收治的超声检查确诊为Ⅰ型、Ⅱ型CSP并接受治疗的191例患者的临床资料,并根据清宫术前不同处理方法分为药物组(n=67)和HIFU组(n=124)。接受药物保守治疗或HIFU治疗预处理后,行超声监测下负压吸引清宫术,评价两种预处理方式的有效性及安全性。结果:药物组与HIFU组患者在年龄、剖宫产次数、孕周、孕囊最大径、切口妊娠次数、预处理前血β人绒毛膜促性腺激素(β-hCG)水平、有孕囊心管搏动、胎芽大小、有生育要求占比差异无统计学意义(P>0.05),而HIFU组Ⅱ型切口占比较药物组更高(P<0.05)。两组患者术中出血量、预处理后治疗结局有效率、术后阴道流血时间、术后宫腔残留、再次手术率、再次妊娠率差异均无统计学意义(P>0.05);两组患者清宫手术时间、预处理后改变手术方式、总住院时间、血β-hCG恢复时间、住院费用差异均有统计学意义(P<0.05)。术后随访至2022年11月,药物组再次妊娠12例、HIFU组再次妊娠16例。结论:对于Ⅰ型、Ⅱ型CSP,行超声监测下负压吸引清宫术前进行HIFU预处理是一种安全有效的治疗方式,提高了治疗效果,减少患者住院时间,可能是临床上对于Ⅰ型、Ⅱ型CSP治疗的一种有效疗法。

Objective:To evaluate the clinical effect of high-intensity focused ultrasound(HIFU)and drug conservative treatment on the treatment of typeⅠand typeⅡcesarean scar pregnancy(CSP).Methods:A retrospective analysis was performed on 191 patients diagnosed with typeⅠand typeⅡCSP by ultrasonography and treated in Mianyang Central Hospital from January 2018 to December 2021,and they were divided into drug group(n=67)and HIFU group(n=124)according to different treatment methods before curettage surgery.After receiving conservative drug treatment or HIFU treatment,preformnegative pressure suction curettage under ultrasound monitoring to evaluate the effectiveness and safety of the two pretreatment methods.Results:There were no significant differences in age,number of cesarean sections,gestational age,the maximum diameter of the gestational sac,number of incision pregnancies,theβ-hCG level before pretreatment,the heart tube pulse in the gestational sac,size of fetal bud,and fertility requirements between the medication group and HIFU group(P>0.05).The proportion of typeⅡincision in HIFU group was higher than that in drug group(P<0.05).There were no significant differences between the two groups in intraoperative bleeding,treatment outcome effective rate after pretreatment,postoperative vaginal bleeding duration,postoperative uterine cavity residual,rate of reoperation and rate of repregnancy(P>0.05).There were statistical differences between the two groups in the operation time of curettage surgery,whether the operation method was changed after pre-treatment,total hospital stay,β-hCG recovery time and hospitalization cost(P<0.05).Following up to November 2022,there were 12 cases re-pregnancies in the drug group and 16 cases re-pregnancies in the HIFU group.Conclusions:For typeⅠand typeⅡCSP,HIFU pretreatment before negative pressure suction curettage under ultrasound monitoring is a safe and effective treatment,which improves the treatment effect and reduces the hospitalization time of patients.It may be an effective clinical therapy for typeⅠand typeⅡCSP treatment.