高强度聚焦超声在剖宫产瘢痕妊娠中的应用

发布时间：2018-04-20 14:41

本文选题：剖宫产瘢痕妊娠 + 高强度聚焦超声　；参考：《南昌大学》2014年硕士论文

【摘要】：目的：观察剖宫产瘢痕妊娠(cesarean scar pregnancy，CSP)使用高强度聚焦超声(high intensity focused ultrasound，HIFU)治疗的临床疗效，为CSP提供更安全、有效的治疗方法。方法：回顾性分析2008年1月至2012年12月收治的220例CSP患者的临床资料。分为三组：药物组给予甲氨蝶呤或米非司酮药物治疗48例；介入组行双侧子宫动脉栓塞术（uterine artery embolization，UAE）治疗142例；HIFU组均为自愿接受HIFU治疗患者30例，，三组均联合刮宫术。对所有患者进行随访。比较三组有效率、β-HCG恢复时间、平均住院天数、平均费用、刮宫术中阴道出血量，以及对HIFU组在降低血β-HCG值及病灶周边血管阻力指数（resistance index，RI）的作用等进行统计学分析。结果：三种治疗方法治疗有效率上无显著性差异(P㧐0.05)，治疗后血β-HCG降至正常水平时间、平均住院天数、平均治疗费用、刮宫术中阴道出血量有显著差异(P㩳0.05)：其中药物组血β-HCG值降至正常水平时间较长、平均费用最少、平均住院时间最长、刮宫术中阴道出血量最多；介入组血β-HCG值降至正常水平时间最短、平均费用最高、平均住院时间较长、刮宫术中阴道出血量较多；HIFU组血β-HCG降至正常水平时间最长、平均费用较少、平均住院时间最短、刮宫术中阴道出血量最少。 HIFU组在治疗后1周、4周与治疗前血β-HCG值相比较，差异有统计学意义（P0.05），HIFU治疗CSP对妊娠囊具有杀灭作用，降低血β-HCG值。HIFU组在治疗后1周、4周与治疗前的RI值相比较，差异有统计学意义（P0.05），HIFU可以使CSP病灶区域的微血管产生损伤闭塞作用，使血流减少或消失。结论： 1、三种治疗方法中HIFU治疗CSP具有费用较低、住院时间短的特点。 2、三种治疗方法中HIFU治疗CSP具有出血少的特点。 3、三种治疗方法中HIFU治疗CSP具有损伤小、安全性高的特点。 4、HIFU是临床治疗CSP的一种有效、安全的新方法。
[Abstract]:Objective: To observe the clinical effect of high intensity focused ultrasound (HIFU) on cesarean scar pregnancyn (CSP) in the treatment of cesarean scar pregnancy, and to provide a more safe and effective treatment method for CSP. Methods: The clinical data of 220 patients with CSP from January 2008 to December 2012 were retrospectively analyzed. They were divided into three groups: the drug group (n = 48) received methotrexate or mifepristone (n = 48) and the interventional group (n = 142) underwent bilateral uterine artery embolization (artery). All patients were followed up. The effective rate, the recovery time of 尾 -HCG, the average hospitalization days, the average cost, the amount of vaginal bleeding during curettage, and the effect of HIFU group on reducing the blood 尾 -HCG value and the vascular resistance index around the lesion were analyzed statistically. Results: There was no significant difference in the effective rate of the three treatment methods. After treatment, the blood 尾 -HCG decreased to normal level, the average hospitalization time, the average treatment cost. There was significant difference in vaginal bleeding during curettage. The blood 尾 -HCG value of drug group decreased to the normal level for a long time, the average cost was the least, the average hospitalization time was the longest, and the vaginal bleeding volume during curettage was the most. In the intervention group, the blood 尾 -HCG value decreased to the normal level for the shortest time, the average cost was the highest, and the average hospitalization time was longer. In the HIFU group, the blood 尾 -HCG decreased to the normal level for the longest time, the average cost was less, and the average hospitalization time was the shortest. The volume of vaginal bleeding during curettage was the least. The serum 尾 -HCG value in HIFU group was significantly higher than that in pre-treatment group at 1 week and 4 weeks after treatment. There was a significant difference between P0.05HIFU group and pre-treatment group. The serum 尾 -HCG value was decreased in the HIFU group at 1 week and 4 weeks after treatment, and the RI value before treatment was compared with that in the control group at 1 week and 4 weeks after treatment, and the serum 尾 -HCG value was decreased in the HIFU group at 1 week and 4 weeks after treatment. The difference was statistically significant (P 0.05). HIFU could injure or obliterate the microvessels in the CSP lesion area and decrease or disappear the blood flow. Conclusion: Among the three treatment methods, HIFU has the characteristics of low cost and short hospital stay. Among the three treatment methods, HIFU has the characteristics of less bleeding in the treatment of CSP. Among the three treatment methods, HIFU has the characteristics of low injury and high safety in the treatment of CSP. HIFU is an effective and safe method for the treatment of CSP.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.22;R445.1

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