HIFU联合米非司酮治疗子宫瘢痕部位妊娠临床研究

Clinical Study of HIFU Combined with Mifepristone in Treatment of Uterine Scar Pregnancy

摘要: 评价高强度聚焦超声(HIFU)联合米非司酮治疗子宫剖宫产瘢痕部位妊娠的临床疗效。方法：回顾性分析我院2015年至2018年收治的子宫剖宫产瘢痕部位妊娠病例24例，其中MTX (Methotrexat，甲氨蝶呤)治疗联合米非司酮治疗10例(药物组)，HIFU联合米非司酮治疗14例(HIFU组)，观察两组患者的临床疗效。结果：HIFU联合米非司酮治疗组13例治疗成功，1例阴道出血多急诊开腹手术。MTX联合米非司酮组仅4例保守治疗成功。结论：两组比较差异有统计学意义(P < 0.05)；HIFU组清宫术中出血量、清宫术后阴道流血时间、血HCG恢复至正常时间、月经复潮时间及住院时间均较药物组少，差异有统计学意义(P < 0.05)。HIFU联合米非司酮治疗子宫剖宫产瘢痕部位妊娠较MTX (甲氨蝶呤)联合米非司酮疗效好，是一种安全、有效、无创的治疗方案，值得推广运用。

Abstract: Objective: To evaluate the clinical efficacy of high-intensity focused ultrasound (HIFU) combined with mifepristone in the treatment of cesarean section scar pregnancy. Method: 24 cases of cesar-ean section scars in our hospital from 2015 to 2018, including 10 cases of MTX treatment combined with mifepristone (drug group), 14 cases of HIFU combined with mifepristone (HIFU Group) were retrospectively analyzed, to observe the clinical efficacy of the two groups of patients. Results: 13 cases of HIFU combined with mifepristone were successfully treated, and 1 case of vaginal hemorrhage performed an emergency laparotomy. Only 4 cases of MTX combined with mifepristone were successfully treated conservatively. Conclusion: The difference between the two groups was statistically significant (P < 0.05). The amount of bleeding in the HIFU group, the time of vaginal bleeding after clearing the uterus, the return of blood HCG to normal time, the time of menstrual re-tidal period and the length of hospital stay were all better than the drugs. There were few groups, and the difference was statistically significant (P < 0.05). So, HIFU combined with mifepristone in the treatment of uterine cesarean section scar pregnancy is better than methotrexate combined with mifepristone, which is a safe, effective, non-invasive treatment program, worth promoting.