剖宫产瘢痕妊娠患者接受高强度聚焦超声消融治疗后再次妊娠的结局分析  

Analysis for the second pregnancy outcome of patients with cesarean scar pregnancy treated by high intensity focused ultrasound ablation

作　　者：镡丽霞 郭清[2] 徐锋 TAN Lixia;GUO Qing;XU Feng(The People Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050031,China)

机构地区：[1]河北省石家庄市人民医院,050031 [2]河北省石家庄市第四医院

出　　处：《河北医药》2020年第21期3297-3299,3303,共4页Hebei Medical Journal

基　　金：石家庄市科学技术研究与发展计划(编号:171461623)。

摘　　要：目的探讨剖宫产瘢痕处妊娠(cesarean scar pregnancy,CSP)患者接受高强度聚焦超声消融治疗后再次妊娠的结果,以期提供临床建议和参考。方法选取2013年1月至2017年12月采用高强度超声聚焦(HIFU)消融治疗的CSP病例(n=112),随访其再次妊娠情况;探讨HIFU消融治疗CSP疗效、治疗后成功受孕者的妊娠结局和成功分娩病例母儿结局情况。结果51例有生育需求的CSP患者纳入本研究,接受HIFU消融治疗平均功率为(285.3±17.9)W,平均治疗时间(81.4±30.6)min,治疗成功率为98.0%(50/51),平均住院时间为(8.2±2.9)d,治疗后平均阴道流血时间为(24.4±8.9)d,血人绒毛膜促性腺激素(HCG)下降至正常时间为(29.1±8.2)d。51例中9例(17.6%)受孕失败,42例(82.4%)成功受孕,其中37例(72.5%)宫内孕者(29例成功分娩,8例流产),2例(3.9%)发生输卵管异位妊娠,3例(5.9%)为CSP复发。29例宫内孕成功分娩者受孕与HIFU治疗平均间隔(19.2±8.4)个月,分娩孕周(38.3±1.1)周,平均出生体重(3279.5±291.4)g,2例(6.9%)转NICU治疗。结论HIFU消融治疗CSP是安全、有效的,该疗法微创、精准,且对生育功能影响小;注意对CSP患者“个体化”制定生育计划,再次妊娠时应严格实施孕产期管理,适时终止妊娠。Objective To investigate the second pregnancy outcome of patients with cesarean scar pregnancy(CSP)treated by high intensity focused ultrasound ablation,so as to provide clinical suggestions and reference.Methods A total of 112 patients with CSP who were treated by high intensity focused ultrasound(HIFU)ablation in our hospital from Janurary 2013 to December 2017 were enrolled in the study,who were followed up for the reproductive situation.The therapeutic effects of HIFU ablation,the pregnancy outcome and maternal and neonatal outcomes in successful delivery mothers were observed and analyzed.Results A total of 51 CSP patients with birth demands were enrolled in the study.The average power of HIFU ablation therapy was(285.3±17.9)W,the average treatment time was(81.4±30.6)min,and the success rate was 98.0%(50/51),the average hospitalization time was(8.2±2.9)d,the average vaginal bleeding time after treatment was(24.4±8.9)d,and the time in that the blood HCG decreased to normal levels was(29.1±8.2)d.Moreover the 51 cases,9 cases(17.6%)failed to conception and 42 cases(82.4%)succeeded to conception,of whom,37 cases(72.5%)had intrauterine pregnancy,29 cases successfully delivered and 8 cases had abortion,2 cases(3.9%)had ectopic tubal pregnancy,and 3 cases(5.9%)had recurrence of CSP.The average interval between pregnancy and HIFU treatment was(19.2±8.4)months in 29 cases of successful intrauterine pregnancy.The gestational week of delivery was(38.3±1.1)weeks.The average birth weight of neonates was(3,279.5±291.4)g.In addition 2 cases(6.9%)were transferred to NICU to be treated.Conclusion HIFU ablation in treatment of CSP is safe and effective,which is minimally invasive,accurate and has little influence on reproductive function.It should be paid much attention to the individualized pregnancy planning for the patients with CSP,and it is necessary to perform strctly administration and management for the pregrant women with second pregnancy,and to end the pregnancy timely.

关 键 词：剖宫产瘢痕处妊娠 高强度超声聚焦 妊娠结局 生育功能 

分 类 号：R714.2[医药卫生—妇产科学]