摘要
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.
Abstract
Objective:To evaluate the clinical effect of high-intensity focused ultrasound(HIFU)and drug con-servative treatment on the treatment of type Ⅰ and type Ⅱ cesarean scar pregnancy(CSP).Methods:A retrospec-tive analysis was performed on 191 patients diagnosed with type Ⅰ and type Ⅱ CSP by ultrasonography and trea-ted 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 receiv-ing 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 sig-nificant differences in age,number of cesarean sections,gestational age,the maximum diameter of the gestational sac,number of incision pregnancies,the β-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 type Ⅱ incision in HIFU group was higher than that in drug group(P＜Q.05).There were no signifi-cant differences between the two groups in intraoperative bleeding,treatment outcome effective rate after pretreat-ment,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 curet-tage 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 type Ⅰ and type Ⅱ CSP,HIFU pretreatment before negative pressure suction curettage under ultrasound monitoring is a safe and effective treat-ment,which improves the treatment effect and reduces the hospitalization time of patients.It may be an effective clinical therapy for type Ⅰ and type Ⅱ CSP treatment.
国家科技期刊平台
NSTL
维普
万方数据