Zhu X G, Shi Q L, Deng X L, Xu W, Xue M
Department of Obstetrics and Gynecology, the Third Xiangya Hospital of Central South University, Changsha 410013, China.
State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China.
Zhonghua Fu Chan Ke Za Zhi. 2022 Apr 25;57(4):253-258. doi: 10.3760/cma.j.cn112141-20210902-00483.
To investigate the clinical effect of focused ultrasound ablation surgery (FUAS) combined with suction curettage for mass-type cesarean scar pregnancy (CSP) and to analyze the influencing factors of vaginal bleeding and readmission. From January 2014 to December 2020, 88 patients with mass-type CSP were treated by FUAS combined with suction curettage in the Third Xiangya Hospital of Central South University. The clinical results and the influencing factors of bleeding and readmission for mass-type CSP were analyzed. All the patients underwent one time FUAS treatment successfully. Immediately after FUAS treatment, color Doppler ultrasound showed obvious necrosis and no perfusion area in all lesions, and the blood flow in the mass-type CSP tissue significantly decreased. The median volume of blood loss in the procedure was 20 ml (range: 5-950 ml). Thirteen patients (15%, 13/88) had vaginal bleeding≥200 ml, and 15 patients (17%, 15/88) were hospitalized again. The average time for menstruation recovery was (28±8) days (range: 18-66 days). The average time needed for serum human chorionic gonadotropin-beta subunit to return to normal levels was (22±6) days (range: 7-59 days). The risk of large vaginal bleeding of patients were related to the blood supply of the mass (=5.280, 95%: 1.335-20.858, =0.018) and the largest diameter of the mass (=1.060, 95%: 1.010-1.120, =0.030). The risk of readmission were related to the largest diameter of the mass (=1.055, 95%: 1.005-1.108, =0.030) and the depth of the uterus cavity (=1.583, 95%: 1.015-2.471, =0.043). No serious complications such as intestinal and nerve injury occurred during and after FUAS treatment. FUAS combined with suction curettage is safe and effective in treating patients with mass-type CSP through this preliminary study. The volume of vaginal bleeding are associated with the blood supply of the mass and the largest diameter of the mass, the risk of readmission are related to the largest diameter of the mass and the depth of the uterus cavity.
探讨聚焦超声消融手术（FUAS）联合刮宫术治疗肿块型剖宫产瘢痕妊娠（CSP）的临床效果，并分析阴道出血及再次入院的影响因素。2014年1月至2020年12月，中南大学湘雅三医院对88例肿块型CSP患者采用FUAS联合刮宫术进行治疗。分析肿块型CSP的临床疗效及出血和再次入院的影响因素。所有患者均成功接受了1次FUAS治疗。FUAS治疗后即刻，彩色多普勒超声显示所有病灶均有明显坏死且无灌注区，肿块型CSP组织内血流明显减少。术中出血量中位数为20 ml（范围：5 - 950 ml）。13例患者（15%，13/88）阴道出血≥200 ml，15例患者（17%，15/88）再次住院。月经恢复平均时间为（28±8）天（范围：18 - 66天）。血清人绒毛膜促性腺激素β亚基恢复正常水平平均所需时间为（22±6）天（范围：7 - 59天）。患者发生大量阴道出血的风险与肿块血供（=5.280，95%：1.335 - 20.858，=0.018）及肿块最大直径（=1.060，95%：1.010 - 1.120，=0.030）有关。再次入院风险与肿块最大直径（=1.055，95%：1.005 - 1.108，=0.030）及子宫腔深度（=1.583，95%：1.015 - 2.471，=0.043）有关。FUAS治疗期间及治疗后未发生肠管及神经损伤等严重并发症。通过本初步研究表明，FUAS联合刮宫术治疗肿块型CSP患者安全有效。阴道出血量与肿块血供及肿块最大直径有关，再次入院风险与肿块最大直径及子宫腔深度有关。
