高强度聚焦超声联合超声监控下清宫术治疗 子宫切口瘢痕妊娠疗效观察

Safety and effectiveness of HIFU combined with ultrasound-guided curettage for caesarean scar pregnancy

摘要:

目的：评价高强度聚焦超声（high-intensity focused ultrasound，HIFU）联合超声监控下清宫术治疗Ⅱ型子宫下段剖宫产切口瘢痕妊娠（caesarean scar pregnancy，CSP）的安全性及有效性。方法：根据孕囊最大径，将82例在遂宁市中心医院治疗的Ⅱ型CSP患者分为3组：10~mm组、20~mm组、30~mm组；3组患者均在接受HIFU消融后行超声监控下清宫术，术中清宫100 mL出血量作为安全性指标，并以术后超声显示宫腔线清晰、无异常回声为有效指标。结果：3组患者人数分别为23例、36例、23例，各组HIFU治疗功率分别为397（350~399）、399（387~400）、400（399~400） W（P=0.000）。HIFU治疗时间分别为37.0（27.0~48.0）、62.0（37.5~78.0）、64.0（46.0~84.0） min（P=0.001），辐照时间中位数分别为250（200~321）、415（252~680）、522（400~800） s （P=0.000），平均治疗强度分别为（435.7±128.0）、（487.0±105.1）、（558.4±118.9） s/h（P=0.002）。3组患者在清宫术中出血量分别为20（10~30）、20（15~35）、30（20~100） mL（P=0.000）。孕囊直径越大，HIFU治疗时给予的治疗功率、治疗强度越大，辐照时间、治疗时间越长，清宫术中出血量越多；3组在清宫术后血清β-人绒毛膜促性腺激素（human chorionic gonadotropin β-sub－unit，β-hCG）恢复正常的中位数时间分别为25（24~31）、27（23~30）、31（24~37） d（P=0.248），组间无明显统计学差异。结论：HIFU治疗联合超声监控下清宫术治疗Ⅱ型瘢痕妊娠，尤其是孕囊直径<30 mm的CSP患者是安全及有效的；对于孕囊较大的患者，HIFU治疗时应给予更高治疗剂量、更长治疗时间以达到有效减少病灶血供，减少清宫时出血的风险。

Abstract:

Objective：To evaluate the safety and effectiveness of high intensity focused ultrasound（HIFU） combined with ultrasound-guided curettage for treating type Ⅱ caesarean scar pregnancy（CSP）. Methods：Eighty-two patients with type Ⅱ CSP from Suning Central Hospital were divided into 3 groups based on the diameter of pregnancy sac：10-mm group，20-mm group，30-mm group. All the patients from the three groups were first treated with HIFU，and then had ultrasound-guided curettage. Results：The number of the three groups was 23，36，23 respectively. The sonication power used for the three groups was 397（350 to 399），399（387 to 400），400（399 to 400） W respectively（P=0.000）. The treatment time for the three groups was 37.0（27.0 to 48.0），62.0（37.5 to 78.0），64.0（46.0 to 84.0） min respectively（P=0.001）. The sonication time for the three groups was 250（200 to 321），415（252 to 680），522（400 to 800） s respectively（P=0.000）. The average sonication intensity for the three groups was （435.7±128.0），（487.0±105.1），（558.4±118.9） s/h，respectively（P=0.002）. The median blood loss in the procedure of curettage was 20（10 to 30），20（15 to 35），30（20 to 100） mL respectively（P=0.000）. When treating the bigger size sac，the higher the treatment power and treat－ment intensity，the longer sonication time and treatment time，and more blood loss during curettage was observed（P<0.05）. The median time of human chorionic gonadotropin（β-hCG） level returning to nomal was 25（24 to 31），27（23 to 30），31（24 to 37）d respectively. No statistically significant difference was observed among the three groups（P=0.248）. Conclusion：HIFU combined with ultrasound-guided curettage can be safely used to treat CSP，especially for the sac smaller than 30 mm. For CSP patients with large sac，higher son－ication power and longer sonication time should be given to reduce the blood supply of sac，and therefore to reduce the risk of massive bleeding during curettage.