【作者】 王智；

【导师】 邹建中； 金成兵； 李承志；

【作者基本信息】 重庆医科大学 ， 妇产科， 2014， 硕士

【摘要】 目的：探讨HIFU联合清宫术用于治疗终止剖宫产后切口部位妊娠,了解治疗效果,并评价其临床应用价值。方法：收集2014年1月至2014年3月就诊于湖南省长沙市湘雅三医院13例子宫切口妊娠患者的病例治疗资料,13例患者在明确诊断为切口妊娠后行高强度聚焦超声(HIFU)治疗,HIFU术后3-4天行清宫术。从患者一般资料、HIFU术中灰度变化及超声造影结果、清宫术时手术时间、术中出血量、术后阴道流血时间、血β-HCG恢复并降至正常的时间、月经恢复时间以及住院时间和总费用等方面进行评价。结果：1.HIFU术中及术后情况13例患者均成功完成高强度聚焦超声治疗。总治疗时间：46min-160min,总辐照时间300S-1538S；术中机载超声提示11例可见团块状灰度变化,13例整体灰度变化,CDFI:13例均未见明显血流灌注,对比术前、术后超声造影检查结果：孕囊及周边组织血流灌注明显减少。术后1-3天复查血β-HCG:11例患者血β-HCG均有不同程度下降,2例患者血β-HCG未见明显升高或下降。2.清宫术后情况13例患者于HIFU治疗后3-4天行清宫术,手术时间：15-56min,总出血量：15-500ml；术后阴道流血时间：1-13天；血β-HCG值恢复正常时间：10-35天；月经恢复正常时间：25-45天；术后随访1-3月,13例患者均未出现其他并发症。3.住院时间及住院费用13例患者总住院时间：5-10天；住院费用：15765.88-19305.16元,住院时间及住院费用明显少于采用子宫动脉介入栓塞术、开腹或腹腔镜手术治疗者。结论：HIFU联合清宫术治疗子宫切口部位妊娠安全有效、风险小、费用少,值得临床推广应用。更多还原

【Abstract】 Objective:To explore the application value of high intensity focused ultrasound combined with uterine curettage in the treatment of uterine incision pregnancy.Methods:From2014January to2014March in Hunan Province, Changsha City Xiangya Hospital,13cases of uterine incision pregnancy cases in treatment of data, all patients diagnosed as pregnancy incision after high intensity focused ultrasound (HIFU) treatment,3-4days after curettage. From the general data of patients, intraoperative ablation time and the amount of bleeding, postoperative recovery time, menstrual blood p-HCG recovered and returned to normal time and hospitalization time and total cost were evaluated.Results:1.HIFU surgery13patients were successfully completed with high intensity focused ultrasound treatment, the total treatment time:46min-160min, total radiation time300S-1538S, the intensity of treatment:391-666S/h;13cases of postoperativeultrasonography results compared with preoperative ultrasonography of gestational sac and surrounding tissue blood perfusion indicate significantly reduced.1-3days after treatment the blood serum β-HCG β-HCG:11patients have varying degrees of decline,2patients blood β-HCG had no obvious increase or decrea。2.After curettage situation13patients in HIFU treatment3-4days after curettage, operation time:15-56min,the total amount of bleeding:15-500ml; postoperative vaginal bleeding time:1-13days; the blood β-HCG values returned to normal time:10-35days; menstrual recovery time:25-45days; the patients were followed up for1-3months,13patients had no other complications。3.The time and expenditure in hospitalA total of13patients hospitalized time:5-10days; hospitalization fee:15765.88-19305.16yuan, hospitalization time and cost of hospitalization was significantly less than the uterine artery embolization and open or laparoscopic operation.Conclusions:High intensity focused ultrasound combined with curettage for the treatment ofuterine incision pregnancy is safe and effective, worthy of clinical application.更多还原