超声引导下清宫术前高强度聚焦超声或子宫动脉栓塞治疗剖宫产瘢痕妊娠的临床疗效及再次妊娠结局：一项回顾性队列研究。
Clinical efficacy and re-pregnancy outcomes of patients with previous cesarean scar pregnancy treated with either high-intensity focused ultrasound or uterine artery embolization before ultrasound-guided dilatation and curettage: a retrospective cohort study.
机构信息
State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China.
Department of Gynecology, Affiliated Hospital of Zunyi Medical University, Guizhou, 563000, China.
出版信息
BMC Pregnancy Childbirth. 2023 Feb 1;23(1):85. doi: 10.1186/s12884-023-05376-0.
BACKGROUND
Cesarean scar pregnancy (CSP) treated with either high-intensity focused ultrasound ablation (HIFU-a) or uterine artery embolization (UAE) combined with ultrasound-guided dilation and curettage (USg-D&C) was effective. However, there is insufficient comparative research evidence on clinical efficacy and subsequent pregnancy outcomes after previous CSP treatment. This study aims to investigate the efficacy, safety, and subsequent pregnancy outcomes of HIFU-a compared to UAE before USg-D&C for the treatment of CSP.
METHODS
Between January 2016 and July 2020, a total of 272 patients received the pretreatment with HIFU-a or UAE(HIFU-a group: n = 118; UAE group: n = 154). The clinical characteristics, treatment success rate, postoperative pregnancy rate and outcome of the two groups were compared and analyzed.
RESULTS
The demographic characteristics of the two groups were similar. After pretreatment, the adverse events rate of HIFU-a group was lower than that of UAE group (10.40% (16/154) vs. 40.70% (48/118), P = 0.00). All patients received the USg-D&C. The HIFU-a group was of less intraoperative blood loss (10.00 (5.00-20.00) vs. 12.50 (5.00-30.00) ml, P = 0.03). There was no statistically significant difference between the two groups in success rates. However, the HIFU-a group was of a shorter duration of postoperative vaginal bleeding (12.00 (9.00-13.00) vs. 14.00 (12.00-15.00) days, P = 0.00). There was no significant difference between the two groups in terms of subsequent pregnancy rates (P = 0.317). However, the recurrent CSP (rCSP) rate in the HIFU-a group was lower than that in the UAE group (7.70% (6/78) vs. 19.70%(13/66), P = 0.03).
CONCLUSIONS
CSP treated with either HIFU-a or UAE combined with USg-D&C was safe and effective. Although no significant difference was found in the subsequent pregnancy outcomes of the two groups, the rCSP was more common in the UAE group. So, we recommend HIFU-a combined with USg-D&C treatment modality.
背景
高强度聚焦超声消融（HIFU-a）或子宫动脉栓塞（UAE）联合超声引导下清宫术（USg-D&C）治疗剖宫产瘢痕妊娠（CSP）效果显著。然而，对于先前 CSP 治疗后的临床疗效和后续妊娠结局，尚缺乏足够的对比研究证据。本研究旨在探讨 HIFU-a 与 UAE 联合 USg-D&C 预处理治疗 CSP 的疗效、安全性及后续妊娠结局。
方法
2016 年 1 月至 2020 年 7 月，共 272 例患者接受 HIFU-a 或 UAE 预处理（HIFU-a 组：n=118；UAE 组：n=154）。比较分析两组患者的临床特征、治疗成功率、术后妊娠率及结局。
结果
两组患者的一般资料无统计学差异。预处理后，HIFU-a 组不良反应发生率低于 UAE 组（10.40%（16/154）比 40.70%（48/118），P=0.00）。所有患者均接受 USg-D&C 治疗。HIFU-a 组术中出血量较少（10.00（5.00-20.00）比 12.50（5.00-30.00）ml，P=0.03）。两组治疗成功率无统计学差异。然而，HIFU-a 组术后阴道出血时间较短（12.00（9.00-13.00）比 14.00（12.00-15.00）天，P=0.00）。两组后续妊娠率无统计学差异（P=0.317）。然而，HIFU-a 组再次发生 CSP（rCSP）的发生率低于 UAE 组（7.70%（6/78）比 19.70%（13/66），P=0.03）。
结论
HIFU-a 或 UAE 联合 USg-D&C 治疗 CSP 安全有效。虽然两组患者的后续妊娠结局无统计学差异，但 UAE 组 rCSP 更为常见。因此，我们推荐 HIFU-a 联合 USg-D&C 治疗方式。
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