HIFU联合宫腔镜下负压吸宫治疗剖宫产瘢痕妊娠临床观察

Clinical Observation of HIFU Combined with Hysteroscopic Vacuum Suction in the Treatment of Cesarean Section Scar Pregnancy

摘要: 目的：探讨高强度聚焦超声(HIFU)联合宫腔镜下负压吸宫术治疗剖宫产瘢痕妊娠(CSP)的临床效果。方法：回顾性分析2017年1月至2019年5月在本院经HIFU治疗后行宫腔镜指导下负压吸宫术清宫治疗的31例CSP患者，观察治疗的有效性及安全性。结果：HIFU治疗后孕囊的原始心管搏动消失，孕囊周边血流信号显著减少。吸宫术中中位出血量30 (10~500) mL。孕囊大小和CSP类型是影响出血量的危险因素，如孕囊偏大或者孕囊凸向膀胱，吸宫术中可能发生大出血。出血量大则需要手术治疗的几率增加，但未发现严重并发症发生。结论：HIFU联合宫腔镜下负压吸宫术治疗I型及II型CSP有效。

Abstract: Objective: To investigate the clinical effect of high intensity focused ultrasound (HIFU) combined with hysteroscopic vacuum aspiration in the treatment of cesarean section scar pregnancy (CSP). Methods: A retrospective analysis of 31 patients with CSP who underwent hysteroscopic guided hypotonic aspiration and uterine curettage after HIFU treatment from January 2017 to May 2019 was performed to observe the efficacy and safety of the treatment. Results: The original cardiac pulsation of the gestational sac disappeared after HIFU treatment, the blood flow signal around the gestational sac was significantly reduced, and the median amount of bleeding during aspira-tion was 30 (10~500) mL. The size of the gestational sac and the type of CSP are risk factors for the amount of bleeding. For example, if the gestational sac is too large or the gestational sac is convex to the bladder, massive bleeding may occur during aspiration. A large amount of bleeding increases the chance of surgery, but no serious complications have been found. Conclusion: HIFU combined with hysteroscopic vacuum aspiration is effective for the treatment of type I and type II CSP.