子宫瘢痕妊娠清宫术前高强度聚焦超声和子宫动脉栓塞的比较

 目的 比较子宫瘢痕妊娠(cesarean scar pregnancy,CSP) 清宫术前高强度超声聚焦(high intensity focused ultrasound,HIFU)与子宫动脉栓塞(uterine artery embolization, UAE)的差异。方法 回顾性分析2013-01至2018-10武警特色医学中心妇产科收治的77例CSP病例资料,根据清宫术前预处理方法的不同分为两组,海扶组先行高强度超声聚焦治疗,子宫动脉栓塞组先行子宫动脉灌注栓塞治疗,均在治疗后2～3 d再行清宫术。分析孕龄、剖宫产次数、距前次剖宫产时间、妊娠时间、孕囊平均直径、子宫瘢痕处肌层厚度、手术时间、术中出血量、住院时间、住院费用、清宫术时转为开腹手术的例数、手术方式及CSP分型情况等。结果 海扶组术中出血>50 ml的有2例,占5.41%,子宫动脉栓塞组出血>50 ml的有6例,占17.14%,海扶组比例明显低于子宫动脉栓塞组(P＜0.05)。CSPⅢ型的5例患者,其中海扶组有2例,子宫动脉栓塞组有3例,刮宫术时均因出血多转为开腹手术。两组在清宫时间、住院时间和住院费用方面,海扶组明显低于子宫动脉栓塞组,差异有统计学意义(均P＜0.05)。结论 HIFU联合清宫术终止CSP安全、有效。

Comparison of HIFU and UAE pretreatment methods before suction curettage in cesarean scar pregnancy

Objective To compare the difference between high intensity focused ultrasound (HIFU) and uterine artery embolization before suction curettage in cesarean scar pregnancy (CSP).Methods The clinical data on77 cases of CSP treated in the Department of Obstetrics and Gynecology of Featured Medical Center of the Chinese People's Armed Force between January 2013 and October 2018 was retrospectively analyzed. Based on the different pretreatment methods before suction curettage, the patients were randomly divided into two groups: one group treated with HIFU, and the other group receiving uterine artery perfusion embolization. Curettage was conducted 2 or 3 days after treatment. The gestational age, number of times of cesarean section, time interval from the previous cesarean section, estationalduration, average diameter of the gestational sac, thickness of the myometrium in the scar of uterus, duration of surgery, amount of intraoperative bleeding, length of hospital stay, cost of hospitalization, number of cases converted to laparotomy during suction curettage, the mode of operation and CSP classification were observed and analyzed.Results There were 2 cases of intraoperative bleeding that exceeded 50 ml in HIFU group (5.41%), compared with 6 cases in uterine artery embolization group (17.14%). Five patients with CSPIII, including 2 in HIFU group and 3 in uterine artery embolization group, were converted to laparotomy because of bleeding during uterine curettage. The duration of uterine curettage, length of hospital stay and cost of hospitalization in HIFU group were significantly shorter or lower than those in uterine artery embolization group (P<0.05).Conclusions The management of CSP by HIFU combined with suction curettage is safe and effective.