高强度聚焦超声联合甲氨蝶呤在瘢痕子宫妊娠行宫腔镜微创清宫术中的应用效果分析

目的 探究采用高强度聚焦超声(HIFU)联合甲氨蝶呤(MTX)在瘢痕子宫妊娠行宫腔镜微创清宫术中的应用效果。方法 选择2018年5月—2019年5月在本院接受宫腔镜治疗的108例瘢痕子宫妊娠患者,依据随机数字表法分为研究组与对照组,每组各54例。对照组使用HIFU预处理,研究组则使用HIFU联合MTX的方式预处理,处理后两组均行宫腔镜辅助微创清宫术。通过随访分析比较两组的治疗效果及妊娠结局。结果 研究组术后7 d血清β-HCG水平为(28 598.38±2 176.52)U/L,低于对照组的(32 423.13±2 734.65)U/L,差异有统计学意义(t=8.042,P<0.001);研究组血清β-HCG转阴时间、月经恢复时间、住院时间分别为(21.33±3.78)d、(28.21±3.83)d、(6.53±2.12)d,分别短于对照组的(26.72±4.83)d、(33.82±4.91)d、(9.53±2.67)d,差异具有统计学意义(t=6.458、6.620、6.466,P均<0.001)。两组均随访≥24个月,宫内妊娠、未孕、流产、再次瘢痕子宫妊娠、异位妊娠比较,差异无统计学意义(χ^(2)=1.895,P>0.05);宫内妊娠中足月分娩与早产比较,差异无统计学意义(χ^(2)=0.131,P>0.05),研究组并发症发生率为22.58%,低于对照组的37.50%,差异有统计学意义(χ^(2)=5.296,P=0.021)。结论 在宫腔镜辅助微创清宫术治疗瘢痕子宫妊娠前使用HIFU联合MTX预处理的效果优于单一使用HIFU预处理,可明显缩短患者血清β-HCG转阴时间、月经恢复时间与住院时间,但对女性的妊娠结局无影响,妇产科临床治疗前可结合患者需求择取最合适的预处理方案。

Analysis of application effect of high intensity focused ultrasound combined with methotrexate in hysteroscopic minimally invasive curettage of scar uterine pregnancy

Objective To explore the application effect of high intensity focused ultrasound (HIFU) combined with methotrexate (MTX) in hysteroscopic minimally invasive curettage of scar uterine pregnancy. Methods A total of 108 patients with scar uterine pregnancy who received hysteroscopy in our hospital from May 2018 to May 2019 were selected and divided into a study group and a control group according to the random number table method, with 54 cases in each group. The control group was pretreated with HIFU, and the study group was pretreated with HIFU combined with MTX. After treatment, both groups underwent hysteroscopy-assisted minimally invasive uterine curettage. The therapeutic effects and pregnancy outcomes of the two groups were compared by follow-up analysis. Results The average serum level of β-HCG at 7 days after operation in the study group was (28 598.38±2 176.52) U/L, which was lower than (32 423.13±2 734.65) U/L in the control group, and the difference was statistically significant (t=8.042, P<0.001). The average serum β-HCG negative conversion time, menstrual recovery time, and hospitalization time of the study group were (21.33±3.78) d, (28.21±3.83) d, and (6.53±2.12) d, respectively, which were shorter than those of the control group. (26.72±4.83) d, (33.82±4.91) d, and (9.53±2.67) d, and the differences were statistically significant (t=6.458, 6.620, 6.466, all P<0.001). Both groups were followed up for more than 24 months, and there was no statistically significant difference in intrauterine pregnancy, non-pregnancy, abortion, scar uterine pregnancy again, and ectopic pregnancy (χ2=1.895, P>0.05). There was no significant difference between term delivery and premature delivery in intrauterine pregnancy (χ2=0.131, P>0.05). The incidence of complications in the study group was 22.58%, which was lower than 37.50% in the control group, and the difference was statistically significant (χ2=5.296, P=0.021). Conclusions The effect of HIFU com-bined with MTX pretreatment before hysteroscopy-assisted minimally invasive uterine curettage is better than that of HIFU pretreatment alone, which can significantly shorten the time of serum β-HCG clearance, menstrual recovery time, and length of hospital stay, but has no effect on the pregnancy outcome of women. The most appropriate pretreatment regimen can be selected according to the needs of patients before clinical treatment in the department of obstetrics and gynecology.