Fang Shanyu, Zhang Ping, Zhu Yuanfang, Wang Fen, He Linsheng
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Department of Otorhinolaryngology Head and Neck Surgery, Jiujiang University Hospital, Jiujiang University Clinical Medical College, Jiujiang, China.
Front Surg. 2020 May 27;7:23. doi: 10.3389/fsurg.2020.00023. eCollection 2020.
This study aims to retrospectively analyze the clinical curative effects of surgery, uterine artery embolization (UAE), and high-intensity focused ultrasound (HIFU) in order to provide the theory and evidences for selecting the optimal treatment for cesarean scar pregnancy (CSP). Women with CSP were treated with surgery (laparoscopic, hysteroscopy, and hysteroscopy-laparoscopic surgery), UAE combined with curettage, and HIFU combined with curettage. The general conditions and therapeutic effects, including vital signs during the operation, discomfort of discharge, cure rate, total blood loss, decline in the rate of hCG, and hospital stay, were compared and analyzed. For the 154 CSP patients, the cure rate of surgery ( = 95) was 97.89%, the cure rate of UAE ( = 32) was 43.74%, and the cure rate of HIFU ( = 27) was 70.37%. The difference was statistically significant ( < 0.05). Furthermore, the hCG level of surgical patients quickly declined, whereas HIFU slowly declined. The difference between the decline rate of hCG and mean hospitalization time was statistically significant ( < 0.05). UAE was good for CSP with gestational age <60 days and diameter of gestational sac <40 mm. Furthermore, HIFU was well for CSP patients with a gestational age of <55 days and a gestational sac diameter of <30 mm. Surgery was suitable for any type of these cases. CSP patients with short gestational age and small gestational sac can be treated with surgery, UAE, and HIFU, and achieve safe and effective therapeutic effects. Surgery is also a good choice for CSP for patients with a long gestational age, a large gestational sac diameter, high levels of hCG, or an ample blood supply.
本研究旨在回顾性分析手术、子宫动脉栓塞术（UAE）和高强度聚焦超声（HIFU）的临床疗效，以便为剖宫产瘢痕妊娠（CSP）选择最佳治疗方法提供理论依据和证据。对CSP患者采用手术（腹腔镜、宫腔镜及宫腹腔镜联合手术）、UAE联合刮宫术、HIFU联合刮宫术进行治疗。比较并分析患者的一般情况及治疗效果，包括术中生命体征、出院时不适情况、治愈率、总失血量、hCG下降率及住院时间。154例CSP患者中，手术组（n = 95）治愈率为97.89%，UAE组（n = 32）治愈率为43.74%，HIFU组（n = 27）治愈率为70.37%。差异有统计学意义（P < 0.05）。此外，手术患者的hCG水平迅速下降，而HIFU组下降缓慢。hCG下降率与平均住院时间的差异有统计学意义（P < 0.05）。UAE对孕周<60天且孕囊直径<40 mm的CSP效果良好。此外，HIFU对孕周<55天且孕囊直径<30 mm的CSP患者效果良好。手术适用于任何类型的此类病例。孕周短、孕囊小的CSP患者可采用手术、UAE和HIFU治疗，并取得安全有效的治疗效果。对于孕周长、孕囊直径大、hCG水平高或血供丰富的CSP患者，手术也是一个不错的选择。
