【摘要】：目的： 探討HIFU聯(lián)合清宮術(shù)用于治療終止剖宮產(chǎn)后切口部位妊娠,了解治療效果,并評價其臨床應(yīng)用價值。 方法： 收集2014年1月至2014年3月就診于湖南省長沙市湘雅三醫(yī)院13例子宮切口妊娠患者的病例治療資料,13例患者在明確診斷為切口妊娠后行高強(qiáng)度聚焦超聲(HIFU)治療,HIFU術(shù)后3-4天行清宮術(shù)。從患者一般資料、HIFU術(shù)中灰度變化及超聲造影結(jié)果、清宮術(shù)時手術(shù)時間、術(shù)中出血量、術(shù)后陰道流血時間、血β-HCG恢復(fù)并降至正常的時間、月經(jīng)恢復(fù)時間以及住院時間和總費(fèi)用等方面進(jìn)行評價。 結(jié)果： 1.HIFU術(shù)中及術(shù)后情況 13例患者均成功完成高強(qiáng)度聚焦超聲治療。總治療時間：46min-160min,總輻照時間300S-1538S；術(shù)中機(jī)載超聲提示11例可見團(tuán)塊狀灰度變化,13例整體灰度變化,CDFI:13例均未見明顯血流灌注,對比術(shù)前、術(shù)后超聲造影檢查結(jié)果：孕囊及周邊組織血流灌注明顯減少。術(shù)后1-3天復(fù)查血β-HCG:11例患者血β-HCG均有不同程度下降,2例患者血β-HCG未見明顯升高或下降。 2.清宮術(shù)后情況 13例患者于HIFU治療后3-4天行清宮術(shù),手術(shù)時間：15-56min,總出血量：15-500ml；術(shù)后陰道流血時間：1-13天；血β-HCG值恢復(fù)正常時間：10-35天；月經(jīng)恢復(fù)正常時間：25-45天；術(shù)后隨訪1-3月,13例患者均未出現(xiàn)其他并發(fā)癥。 3.住院時間及住院費(fèi)用 13例患者總住院時間：5-10天；住院費(fèi)用：15765.88-19305.16元,住院時間及住院費(fèi)用明顯少于采用子宮動脈介入栓塞術(shù)、開腹或腹腔鏡手術(shù)治療者。 結(jié)論： HIFU聯(lián)合清宮術(shù)治療子宮切口部位妊娠安全有效、風(fēng)險小、費(fèi)用少,值得臨床推廣應(yīng)用。
[Abstract]:Objective: to evaluate the clinical value of HIFU combined with hysterectomy in the treatment of termination of pregnancy at the incision site after cesarean section. Methods: from January 2014 to March 2014, 13 cases of pregnant women with uterine incision in Xiangya third Hospital, Changsha City, Hunan Province, were collected. Thirteen patients were treated with high intensity focused ultrasound (HIFU) (HIFU) after definite diagnosis of incisional pregnancy, and 3 days after HIFU, uterine debridement was performed. From the general data of the patients, the results of contrast-enhanced ultrasound and gray-scale changes during HIFU, the time of operation, the amount of bleeding during the operation, the time of bleeding after operation, the time of blood 尾-HCG returning to normal, the time of recovery and reduction of 尾-HIFU to normal. Menstrual recovery time and hospital stay and total costs were evaluated. Results: high intensity focused ultrasound (HIFU) was successfully completed in 13 patients during and after 1.HIFU. The total treatment time was 46 min / 160 min and the total irradiation time was 300 S / 1538 S; The changes of mass gray scale were observed in 11 cases, global gray scale in 13 cases, and no obvious blood perfusion was found in CDFI:13 cases. The results of contrast-enhanced ultrasonography before and after operation showed that the blood perfusion of pregnancy sac and peripheral tissue decreased obviously. On the 3rd day after operation, 尾-HCG:11 decreased in all the patients, but there was no significant increase or decrease in 尾-HCG in 2 patients. 2. 13 patients underwent hysterectomy 3 days after HIFU treatment, the total bleeding volume was 15 脳 500 ml, the vaginal bleeding time was 1 day 13 days, the serum 尾-HCG value returned to normal time 10 days 35 days, the operation time was 15 minutes 56 minutes, the total bleeding volume was 15 渭 500 ml, the vaginal bleeding time was 1 day 13 days, the blood 尾-HCG value returned to normal time 10 days 35 days. After 1-3 months follow-up, there were no other complications in 13 patients. 3. The total hospitalization time and expenses of 13 patients were 5 to 10 days and 15765.88 yuan, 19305.16 yuan respectively. The length of hospital stay and the cost of hospitalization were significantly less than those treated by uterine artery interventional embolization, laparotomy or laparoscopy. The total length of hospital stay and total hospitalization cost were 5 days and 10 days, and 15765.88 yuan 19305.16 yuan respectively. Conclusion: HIFU combined with hysterectomy is safe and effective in the treatment of uterine incision pregnancy with low risk and low cost. It is worth popularizing and applying in clinical practice.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R713.8

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1 嚴(yán)崴巍;;介入技術(shù)加清宮術(shù)治療剖宮產(chǎn)子宮切口疤痕妊娠8例[J];中國醫(yī)藥導(dǎo)刊;2011年11期

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