【摘要】 目的回顾性分析宫腔镜手术、子宫动脉栓塞术(UAE)加清宫术及高强度聚焦超声(HIFU)加清宫术治疗子宫瘢痕妊娠(CSP)的临床疗效,为临床选择最佳治疗方法提供依据。方法收集2015年1月至2017年6月经宫腔镜手术(宫腔镜组,200例)、UAE加清宫术(UAE组,64例)、HIFU加清宫术(HIFU组,50例)治疗的CSP患者共314例,比较3种治疗方式的疗效[包括出血量、血人绒毛膜促性腺激素(hCG)下降幅度、住院时间和治疗成功率]。结果宫腔镜、UAE、HIFU 3组治疗成功率分别为99.00%、67.19%、78.00%,宫腔镜组疗效优于其他2组(P<0.05)。3组患者治疗顺利,宫腔镜手术过程中有少量出血;UAE及HIFU治疗过程中无出血,而行清宫术中出血且术后出血量较多,持续时间长。宫腔镜手术治疗患者hCG下降速度最快,HIFU治疗患者hCG下降缓慢,3组患者出血量、hCG下降幅度、平均住院时间比较差异有统计学意义(P<0.05)。结论对于CSP患者,宫腔镜手术安全有效,创伤小,恢复快,治疗效果优于UAE及HIFU。UAE及HIFU对于孕龄短、孕囊体积小的CSP患者,治疗效果好,且安全无创,无需麻醉,HIFU可直接门诊治疗,无需住院。但对于大出血风险高的CSP患者,UAE及HIFU可作为术前辅助治疗,降低囊胚活性及血供,减少术中大出血的风险,提高手术安全性。更多还原

【Abstract】 Objective To retrospectively analyze the clinical effects of hysteroscopic surgery,uterine artery embolization(UAE)combined with curettage and high-intensity focused ultrasound(HIFU)combined with curettage on cesarean scar pregnancy(CSP),and to provide evidence for selecting optimal treatment method for CSP.Methods Data of 314 patients who underwent hysteroscopic surgery(hysteroscopic group,n=200),UAE combined with curettage(UAE group,n=64)or HIFU combined with curettage(HIFU group,n=50)for CSP from January 2015 to June2017 were collected in this study.Blood loss,decrease in hCG,hospital stay and success rate were compared among the three groups.Results The treatment success rate in hysteroscopic group(99.00%)was higher than that in UAE group(67.19%)or that in HIFU group(78.00%)(P<0.05).There was slight bleeding during hysteroscopic surgery.No bleeding occurred during UAE and HIFU.However,the curettage resulted in intraoperative bleeding and a large amount and long duration of postoperative blood loss.The hCG level declined quickly in hysteroscopic group,but slowly in HIFU group.The differences in blood loss,decreased hCG level and hospital stay were significant among the three groups(P<0.05).Conclusion Hysteroscopic surgery is a safe and effective treatment with advantages of less wound and quick recovery,which is superior to UAE or HIFU for treating CSP.Both UAE and HIFU are effective,safe,noninvasive and non-anesthetic methods for treating CSP in patients with short gestational duration and small gestational sac.Furthermore,HIFU can be performed without hospitalization in outpatient clinics.However,for patients with high risk of massive hemorrhage,HIFU or UAE can be used as a preoperative adjuvant therapy to reduce intraoperative bleeding and increase surgical safety.更多还原