聚焦超声消融手术治疗剖宫产瘢痕妊娠多中心研究  

A multicenter study on focused ultrasound ablation surgery for cesarean scar pregnancy

作　　者：朱小刚[1,2] 熊黎 何昌晖 余鸿凡 彭丽秀 程卫[3] 薛敏[1] ZHU Xiao-gang;XIONG Li;HE Chang-hui;YU Hong-fan;PENG Li-xiu;CHENG Wei;XUE Min(不详;Department of Gynecology,the Third Xiangya Hospital of Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院妇科,湖南长沙410013 [2]超声医学工程国家重点实验室,重庆400016 [3]湖南省妇幼保健院妇科,湖南长沙410008 [4]郴州市第一人民医院妇科,湖南郴州423000

出　　处：《中国实用妇科与产科杂志》2024年第9期932-936,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：超声医学工程国家重点实验室开放课题(2020KFA3001);中国博士后科学基金(2021M700639);重庆市博士后科研项目;湖南省妇幼保健院“锐新”培育项目(2021RX28);超声医学工程国家重点实验室开放课题(2023KFKT012)。

摘　　要：目的探讨聚焦超声消融手术(FUAS)治疗不同类型剖宫产瘢痕妊娠(CSP)的临床效果及影响出血量和再入院的相关因素。方法回顾性分析2014年1月至2023年12月在中南大学湘雅三医院、湖南省妇幼保健院及郴州市第一人民医院经FUAS治疗的1581例CSP患者,观察FUAS治疗不同类型CSP的有效性、安全性及影响出血量和再入院的相关因素。结果所有患者均1次完成FUAS消融治疗。FUAS治疗后,彩超显示病灶血流信号显著减少,增强超声造影显示治疗区无强化。妊娠物清除术中(仅1425例记录了出血量),中位出血量为20mL(5~950mL),其中62例(4.4%,62/1425)患者出血量超过200mL,64例(4.0%,64/1581)患者术后再次住院。病灶血供(P=0.006)及病灶最大径(P=0.03)是影响妊娠物清除术中出血量的危险因素,病灶血供越丰富(3~4级)、病灶越大(最大径超过30.5mm),越有可能发生出血量多。CSP分型(P=0.01)是患者再次住院的影响因素,Ⅲ型CSP更可能需再次入院手术清宫。FUAS治疗后均无肠道及神经损伤等严重并发症发生。结论FUAS联合妊娠物清除术治疗不同类型CSP均安全有效。病灶3~4级血供及病灶最大径超过30.5mm的CSP患者出血风险更高,Ⅲ型CSP患者更可能需再次住院清宫。Objective To investigate the clinical efficacy of focused ultrasound ablation surgery(FUAS)for different types of cesarean scar pregnancy(CSP)and the factors affecting bleeding volume and readmission.Methods From January 2014 to December 2023,1581 patients with cesarean scar pregnancy were treated by FUAS in the 3rd Xiangya Hospital of Central South University,Hunan Maternal and Child Health Care Hospital,and Chenzhou First People's Hospital,and their data were retrospectively analyzed.The efficacy and safety of FUAS for different types of CSP,and the influencing factors of bleeding volume and readmission were analyzed.Results All the patients completed FUAS successfully in one session.After FUAS,color Doppler ultrasound showed a significant decrease in blood flow signal,while contrast-enhanced ultrasound showed no enhancement in the treated area.The median volume of blood loss in curettage was 20mL(range:5-950mL).The amount of bleeding volume more than 200mL was observed in 62 patients(4.4%,62/1425),and 64 patients(4.0%,64/1581)were readmitted after curettage.The blood supply of the mass(P=0.006)and the largest diameter of the mass(P=0.03)were the risk factors affecting the amount of bleeding during curettage.The lesions with blood supply of grades 3-4 and the size larger than 30.5mm were more likely to lead to major bleeding.The risk of readmission was related to the type of CSP(P=0.01),and the risk of readmission of patients was increased by 3rd type of CSP.No serious complications such as intestinal and nerve injury occurred during FUAS.Conclusions FUAS combined with curettage is safe and effective in the treatment of different types of CSP.The blood supply of grades 3-4and the largest diameter more than 30.5mm of the lesion are more likely to result in bleeding,and the patients with 3rd type CSP have a higher risk of readmission.

关 键 词：剖宫产瘢痕妊娠 聚焦超声消融手术 有效性 安全性 影响因素 

分 类 号：R714.2[医药卫生—妇产科学]