【摘要】 目的:比较高强度聚焦超声（HIFU）和子宫动脉栓塞术（UAE）预处理后联合超声引导下宫腔镜清宫术（Hys）对Ⅰ、Ⅱ型剖宫产瘢痕妊娠（CSP）患者的疗效分析。方法:回顾分析2018至2022年陕西省人民医院收治的107例CSP患者的临床资料，处理方式分为HIFU+Hys或UAE+Hys,并根据孕囊平均直径（D）分为3组：1.0cm≤D<2.0cm, 2.0cm≤D<3.0cm, D≥3.0cm。比较各组患者的年龄、体质量指数（BMI）、孕次、剖宫产次数、本次妊娠距上次剖宫产时间、手术时间、术中出血量，手术前后血人绒毛膜促性腺激素（HCG）数值和血红蛋白（Hb）数值（HCG₀、HCG₁、Hb₀、Hb₁）,术中和术后主观不适感（发热、疼痛、急性盆腔炎、腰骶部不适、下肢麻木感、臀部不适）及住院时长。结果:孕囊<3.0cm的CSP患者中，HIFU+Hys组的术中出血量与UAE+Hys组比较，差异无统计学意义（P>0.05）;孕囊≥3.0cm的患者中，UAE+Hys组的术中出血量少于HIFU+Hys组，差异有统计学意义（P≤0.05）。HIFU+Hys组的平均住院时长明显短于UAE+Hys组（P≤0.05）。HIFU+Hys组的术中术后疼痛感及发热率明显低于UAE+Hys组（P≤0.05）。结论:HIFU预处理联合超声引导下宫腔镜清宫术更适合于孕囊直径<3.0cm的CSP患者，而UAE预处理后超声引导下清宫术更适合于孕囊≥3.0cm的CSP患者。更多还原

【Abstract】 Objective:To compare the efficacy of high-intensity focused ultrasound（HIFU） or uterine artery embolization（UAE） after preconditioning combined with ultrasound-guided hysteroscopic hysterectomy（Hys） in patients with type Ⅱ cesarean scar pregnancy（CSP）.Methods:The clinical data of 107 CSP patients admitted to Shanxi Provincial People’s Hospital from 2018 to 2022 were retrospectively analyzed.The treatment methods were divided into HIFU+Hys or UAE+Hys, and they were divided into 3 groups according to the average diameter of the gestational sac（D）,1.0 cm≤D<2.0 cm, 2.0 cm≤D<3.0 cm, D≥3.0 cm.The age, body mass index（BMI）,pregnancy times, cesarean section times, the time from the current pregnancy to the last cesarean section, operation time, intraoperative blood loss, blood flow before and after the operation were compared among the groups.Chorionic gonadotropin（HCG） values and hemoglobin（Hb） values（HCG₀,HCG₁,Hb₀,Hb₁） before and after surgery, intraoperative and postoperative subjective discomfort（fever, pain, acute pelvic inflammatory disease, lumbosacral discomfort, lower extremity numbness, hip discomfort） and length of hospital stay.Results:In CSP patients with gestational sac <3.0 cm, the intraoperative blood loss in the HIFU+Hys group and in the UAE+Hys group were equivalent in value（P>0.05） The intraoperative blood loss was less than that in the HIFU+Hys group（P≤0.05）.The average length of hospital stay in the HIFU+Hys group was significantly shorter than that in the UAE+Hys group（P≤0.05）.The intraoperative and postoperative pain and fever rate in the HIFU+Hys group were also significantly lower than those in the UAE+Hys group（P≤0.05）.Conclusion:HIFU preprocessing combined with hysteroscopic suction curettage guidance ultrasound is more suitable for CSP patients with gestational sac <3.0 cm, while hysteroscopic suction curettage guidance ultrasound after UAE preprocessing is more suitable for CSP patients with gestational sac ≥3.0 cm.更多还原