Comparative study of clinical efficacy of high-intensity focused ultrasound and uterine artery embolization for adjunctive treatment of cesarean scar pregnancy
Objective To investigate the clinical efficacy and safety of high intensity focused ultrasound (HIFU) and uterine artery embolization (UAE) for adjunctive treatment of cesarean scar pregnancy (CSP).Methods From January 2014 to June 2016,a total of 192 CSP patients who made the definite diagnosis in the Northwestern Women and Children's Hospital and were hospitalized for of surgery pregnancy termination,were chosen as research objects.They were divided into HIFU group and UAE group according to the methods of adjunctive treatments of their choice,HIFU group took HIFU (n=102) adjunctive treatment and UAE group took UAE adjunctive treatment (n=90).We used independent-samples t test or chi-square test to compare and analyze the following measurement data or numeration data between two groups:the incidence of adverse reactions after HIFU or UAE treatment,the situations during and after uterine curettage,and the follow-up period observation items.This study was in line with World Medical Association Declaration of Helsinki revised in 2013 and informed contents were obtained from all patients.Results ① There were no significant differences between two groups of patients in general clinical data including patients' age,body mass index (BMI),times of cesarean section,pregnancy time and diameter of pregnancy sac (P＞0.05).②There were no significant differences between two groups of patients in incidence rate of fever after adjunctive treatment,also time of uterine curettage,volume of bleeding during operation,duration of vaginal bleeding after operation and hospital stay after operation (P＞0.05).The visual analogue score (VAS) value and the incidence rate of nausea/vomiting in HIFU group patients after HIFU treatment[(3.2±0.9) scores,7.8％],were all lower than those in UAE group patients after UAE treatment [(3.6±0.9) scores,22.2％],the costs of hospitalization in HIFU group [(16 021±150) yuan] was also lower than that in UAE group [(20 057±164) yuan],and all the differences above were statistically significant (t=3.455,P=0.001;x2 =7.936,P=0.005;t=177.262,P＜ 0.001).③There were no significant differences between two groups of patients in serum hCG negative conversion rates at 2 weeks,1 month,3 months after operation,respectively,and amenorrhoea rate at 12 months after operation (P＞0.05).After 3 and 6 months of operation,the incidence rates of decreased menstrual of HIFU group patients (4.9％,5.9％) were lower than those of UAE group (17.8％,20.0％),and pregnancy again rate of HIFU group patient within 12 months after operation (29.4％) was higher than that of UAE group (15.6％),and all the differences above were statistically significant (x2=8.137,P=0.004;x2 =8.713,P=0.003;x2=5.197,P=0.023).Conclusions HIFU as an adjunctive treatment of CSP has the same clinical efficacy as UAE,caused less adverse reactions and postoperative complications,and it is more suitable as an adjunctive treatment for CSP.
Pregnancy, ectopicUterine artery embolizationExtracorporeal shockwave therapyComparative effectiveness researchPregnant women
NETL
NSTL
万方数据
维普
