Ⅱ型子宫瘢痕妊娠术前HIFU和UAE预处理的比较研究

Comparative research of HIFU and UAE pretreatment before operation for typeⅡcesarean scars pregnancy

目的评估Ⅱ型子宫瘢痕妊娠(CSP)患者宫腔镜手术治疗前高强度聚焦超声(HIFU)或子宫动脉栓塞术(UAE)预处理的有效性及安全性。方法采用回顾性队列研究,选取2019年7月至2020年12月清远市人民医院收治的55例Ⅱ型CSP患者,观察组(24例)宫腔镜手术前采用HIFU,对照组(31例)宫腔镜手术前采用UAE,比较两组患者的术中风险、术后不良反应、术后月经复潮等情况。结果两组术中均未发生大出血、子宫穿孔、水中毒及宫内组织物残留,手术时间、术中出血量差异无统计学意义(P>0.05);观察组术后疼痛、发热的发生率明显低于对照组,但差异无统计学意义(P>0.05);观察组术后连续3次的月经量及月经中期子宫内膜厚度明显高于对照组,差异有统计学意义(P<0.05)。结论对于Ⅱ型CSP患者,宫腔镜术前HIFU或UAE预处理均安全有效,相比于UAE,HIFU联合宫腔镜手术对患者的子宫内膜损伤较小,生育功能影响的可能性小,更适用于有生育要求的患者。

Objective To evaluate the effectiveness and safety of high intensity focused ultrasound(HIFU)or uterine artery embolization(UAE)pretreatment before hysteroscopy in patients with typeⅡcesarean scars pregnancy(CSP).Methods A retrospective cohort research was conducted,and a total of 55 patients with typeⅡCSP admitted to the People’s Hospital of Qingyuan City from July 2019 to December 2020 were selected and divided into the observation group(n=24)and the control group(n=31).The observation group was treated with HIFU before hysteroscopy,while the control group was treated with UAE before hysteroscopy.The intraoperative risks,postoperative adverse reactions(ADRs)and postoperative menstrual regain were compared between the two groups of patients.Results There were no massive hemorrhage,uterine perforation,water intoxication and tissue residue in both groups,and there were no statistically significant differences in operation time and hemorrhage volume(P>0.05).The incidences of postoperative pain and fever in the observation group were significantly lower than those in the control group,without statistically significant differences(P>0.05).The three consecutive menstrual volume and mid-menstrual endometrial thickness in the observation group were significantly higher than those in the control group,with statistical significance(P<0.05).Conclusion For patients with typeⅡCSP,pretreatment with HIFU or UAE before hysteroscopy is safe and effective.Compared with the UAE,the combination of HIFU and hysteroscopy has less damage to the endometrium and less possibility of impacting fertility function,so it is more suitable for patients with fertility requirements.