高强度聚焦超声治疗后子宫肌瘤患者妊娠情况分析  

Analysis of pregnancy outcomes in patients with uterine fibroids after high intensity focused ultrasound treatment

作　　者：许温馨 邹敏 熊郁 黄国华[3] 牟燕[3] 何玉春 何佳[1,3] XU Wen-xin;ZOU Min;XIONG Yu;HUANG Guo-hua;MU Yan;HE Yu-chun;HE Jia(Department of Obstetrics and Gynecology,Zunyi Medical College,Zunyi 563000,China)

机构地区：[1]遵义医学院,贵州遵义563000 [2]重庆海扶医院,重庆401121 [3]遂宁市中心医院妇产科,四川遂宁629000

出　　处：《中国实用妇科与产科杂志》2019年第1期117-122,共6页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨高强度聚焦超声(HIFU)治疗对子宫肌瘤患者妊娠结局的影响。方法回顾性分析2010年10月至2017年10月,在遂宁市中心医院及重庆海扶医院接受HIFU治疗后妊娠的241例子宫肌瘤患者,观察HIFU消融治疗的疗效及患者妊娠结局。结果 HIFU治疗后,9例在HIFU治疗后2个月内妊娠,24例在治疗后2～4个月妊娠,33例患者术后>4～6个月妊娠,175例在HIFU治疗6个月后妊娠。中位妊娠时间为治疗后9个月(1～26个月)。其中152例已顺利分娩;12例仍在妊娠中;3例异位妊娠,2例切口妊娠均经手术治疗;72例流产,包括人工流产66例次,自然流产6例次。人工流产原因包括:胚胎停止发育(8例),阴道流血增多(5例),甲状腺功能减退(1例),孕期使用药物担心胎儿畸形(6例),非计划妊娠(52例)。已分娩的152例中,147例148次足月分娩(1例足月分娩2次),5例早产。妊娠中及分娩时无子宫破裂发生,新生儿健康。HIFU治疗前,241例患者中136例有不良孕产史,HIFU治疗后这些患者中仅17例出现妊娠不良事件。HIFU治疗后自然流产率显著低于治疗前(P<0.05)。结论 HIFU治疗有生育要求的子宫肌瘤患者是安全的,HIFU治疗有助于降低妊娠不良事件的发生率。Objective To investigate the effect of high intensity focused ultrasound(HIFU)on pregnancy outcomes inpatients with uterine fibroids.MethodsFrom October 2010 to October 2017,241 patients with uterine fibroids whowere pregnant after HIFU treatment in Suining Central Hospital and Chongqing Haifu Hospital were retrospectivelyanalyzed.The efficacy of HIFU ablation and the patient′s pregnancy outcomes were investigated.ResultsAmong thesepatients,9 of them were conceived within 2 month after HIFU,24 were conceived between 2 and 4 months after HIFU,33 patients were conceived between 4 and 6 months,and 175 patients were conceived after 6 months of HIFU treatment.The median conception time was 9 months after HIFU(range:1 to 26 months).Among them,152 patients had deliveredbabies successfully,12 patients are still in pregnancy,3 patients had ectopic pregnancy,2 patients had incisionalpregnancy,72 patients had abortions,including 66 cases of induced abortion and 6 cases of spontaneous abortion.Causesof induced abortion included:embryonic development stopping(8 cases),increased vaginal bleeding(5 cases),hypothyroidism(1 case),use of drugs during pregnancy and being fear of fetal malformation(6 cases),and unplannedpregnancy(52 cases).Of the 152 patients who had delivered,147 had 148 full-term deliveries(1 had full-term deliverytwice)and 5 had preterm birth.No uterine rupture occured during pregnancy or childbirth,and the newborn is healthy.Before HIFU treatment,136 of 241 patients had a history of abnormal pregnancy,and only 17 of these patients hadabnormal pregnancy after HIFU treatment.The incidence of spontaneous abortion in patients after HIFU treatment wassignificantly lower than before treatment(P<0.05).ConclusionHIFU is a safe and effective treatment for patients whowish to have children.It can also improve the fertility of patients with a history of abnormal pregnancy,with no additionalobstetric risks.

关 键 词：高强度聚焦超声 子宫肌瘤 妊娠结局 不良孕产史 

分 类 号：R737.3[医药卫生—肿瘤]