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。
Abstract
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.
关键词
子宫瘢痕妊娠 /
高强度聚焦超声 /
子宫动脉栓塞 /
清宫术
Key words
cesarean scar pregnancy /
high-intensity focused ultrasound /
uterine artery embolization /
uterine curettage
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 中华医学会妇产科分会计划生育学组.剖宫产术后子宫瘢痕妊娠诊治专家共识(2016)[J].中华妇产科杂志 ,2016,51(8),568-572.
[2] Riaz R M,Williams T R,Craig B M,et al.Cesarean scarectopic pregnancy: imaging features.currenttreatmentoptions,and clinical outcomes[J].Abdom Imaging,2015,40:2589-2599.
[3] 陈雁鸣,陈素文,赵丽伟,等.剖宫产瘢痕患病率与妊娠次数相关性分析[J].北京医学,2015,37(7):626-628.
[4] Maymon R,Halperin R,Mendlovic S,et al.Ectopic pregnancies in Caesarean scar:review of the medical approach to aniatrogenic complication[J].Hum Reprod Update,2004,10(6):515-523.
[5] Tan G,Chong Y S,Biswas A.Caesarean scar pregnancy:a diagnosis toconsider carefully in patients with risk factor [J].Ann Acad Med Singapore,2005,34(2):216-219.
[6] Maymon R,Halperin R,Mendlovic S,et al.Ectopic pregnancies in Caesarean section scars:The 8 year experience of one medical centre[J].Hum Reprod,2004,19(2):278-284.
[7] Birch Petersen K,Hoffmann E,Rifbjerg Larsen C,et al.Cesarean scar pregnancy:a systematic review of treatment studies[J].Fertil Steril,2016,105(4):958-967.
[8] Sherry L F,Laura A S,Denise J J.Pregnancy loss among pregnancies conceived through assisted reproductivetechnology,United States,1999-2002[J].Am Epidemiol,2007,165 (12 ):1380-1388.
[9] Morris C S.Update on uterine artery embolization for symptomatic fibroid disease (uterine artery embolization)[J].Abdom Imaging,2008,33:104-111.
[10] 王秦芳.子宫瘢痕妊娠子宫动脉栓塞术治疗的疗效及其对卵巢功能的影响[J].中国妇幼保健杂志,2017,32(1):180-182.
[11] 方 圆. 子宫动脉栓塞术治疗剖宫产术后子宫瘢痕妊娠的临床疗效分析及其对卵巢功能的影响[J].实用妇科内分泌电子杂志,2019,6(15):42-44.
[12] Yuh E I,Shulman S G,M ehta S A,et al.Delivery of systemic chemotherapeutic agent to tumors by using focused ultrasound:study in a murine mode1[J].Radiology,2005,234:431-437.
[13] 许正芬,周丽仙,金玉明.高强度超声聚焦联合宫腔镜终止剖宫产术后子宫瘢痕妊娠的疗效与安全性[J].中国医学计算机成像杂志,2017,23(3):279-282.
基金
武警部队军事理论研究计划课题重点项目(WJJY19-514)
PDF(677 KB)
