高强度聚焦超声治疗剖宫产子宫切口瘢痕妊娠21例临床分析及护理

目的探讨高强度聚焦超声热辐照治疗剖宫产子宫切口瘢痕妊娠(caesarean scar pregnancy,CSP)的临床疗效及护理措施。方法对21例CSP患者均采用高强度聚焦超声进行热辐照治疗,同时行相应的护理。观察21例患者治疗后阴道出血时间、血清β-人绒毛膜促性腺激素(beta-human chorionic gonadotropin,β-hCG)恢复并降至正常时间、住院时间、月经恢复时间及临床疗效。结果 21例患者治疗后阴道出血时间1~13d,平均8.1d,血清β-hCG恢复并降至正常时间14~28d,平均21.3d,住院时间5~10d,平均7.6d,月经恢复时间28~42d,平均32.2d。痊愈12例,好转7例(均行清宫术),无效2例(均行经腹妊娠残留物清除术),总有效率为90.48%。21例患者均获随访,随访1~3个月,均未出现并发症。结论高强度聚焦超声治疗CSP具有无创、有效、安全、治疗后机体恢复快和无放射性损伤、无需麻醉及可重复性等优点,同时行相应的护理可以明显提高患者的生活质量。 更多还原     

高强度聚焦超声波对子宫切口妊娠治疗的临床效果观察

目的 探讨高强度聚焦超声波(HIFU)治疗子宫切口妊娠(cesarean scarpregnancy,CSP)的临床疗效.方法 于2011年11月至2012年12月采用高强度聚焦超声波治疗20例子宫切口妊娠患者.比较HIFU治疗前、治疗后第5天、2、4周患者超声声像图及血HCG水平变化.结果 患者血清人绒毛膜促性腺激素(β-HCG)在HIFU治疗前与治疗后5d比较,差异无统计学意义(P＞0.05);而与HIFU治疗后2、4周比较,差异有统计学意义(P＜0.001);在治疗后4周,经阴道彩超显示14例患者病灶完全消失,6例患者子宫切口见一不规则壁薄光滑的无回声区.结论 HIFU是一种安全、有效、实用的治疗子宫切口妊娠的新方法,值得推广和应用.     

高强度聚焦超声联合B超引导下清宫治疗子宫切口妊娠的临床疗效研究

目的 分析高强度聚焦超声（HIFU）+B超引导下清宫子宫切口妊娠（Cesarean scar pregency,CSP）的疗效。方法选取2022年1月至2023年1月我院收治的50例CSP患者，采用抽签法分为对照组和观察组各25例。对照组行甲氨蝶呤（MTX）化疗+清宫治疗，观察组行HIFU+B超引导下清宫治疗。比对两组临床指标（术中出血量、住院时间、术后HCG下降时间、术后月经恢复时间）、一次性治疗成功率和发热发生率。结果 治疗后，观察组术中出血量、住院时间、术后HCG下降时间、术后月经恢复时间均低于对照组，差异有统计学意义（P<0.05）。观察组一次性治疗成功率为92.00%，高于对照组的64.00%，差异有统计学意义（P<0.05）。结论 HIFU+B超引导下清宫的运用，疗效更理想，改善作用好，可以最大限度保留生育功能，利于患者身心健康，值得推广。     

高强度超声聚焦消融术结合宫腔镜治疗子宫瘢痕妊娠临床疗效

目的探讨高强度超声聚焦消融术结合宫腔镜治疗子宫瘢痕妊娠的临床疗效。方法选取收治的子宫瘢痕妊娠患者60例,依据随机数字表法分为对照组和试验组各30例,对照组给予注射甲氨蝶呤联合宫腔镜治疗,试验组在对照组基础上给予高强度超声聚焦消融术治疗。结果试验组术后恢复较对照组明显(P0.05)、手术时间长于对照组(P0.05)、术后并发症明显低于对照组(P0.05)、治疗有效率明显高于对照组(P0.05)。结论高强度超声聚焦消融术结合宫腔镜治疗子宫瘢痕妊娠疗效确切,术后恢复较快,值得临床推广应用。     

高强度聚焦超声联合清宫术治疗剖宫产术后子宫瘢痕妊娠的临床应用

目的 研究分析高强度聚焦超声联合清宫术治疗剖宫产术后子宫瘢痕妊娠的安全有效性。方法 分析我院2014年6月到2016年6月高强度聚焦超声联合清宫术治疗的62例子宫瘢痕妊娠的临床资料,观察患者清宫术中出血量、血清 β -人绒毛膜促性腺激素（beta -human chorionic gonadotropin ,β-hCG）下降情况、月经恢复时间、住院时间及术中术后不良反应。结果 62例子宫瘢痕妊娠患者均成功接受高强度聚焦超声联合清宫术治疗,57例患者显效,4例患者有效,总体有效率98.38%。血β-hCG平均下降17811.59mIU/mL,住院时间5-48d,平均10.2d,月经恢复时间1-3月,平均1.5月。62例患者均接受3个月的随访,无一例出现皮肤烫伤、神经损伤等严重并发症。结论 高强度聚焦超声联合清宫术治疗子宫瘢痕妊娠是一种安全有效的方式。     

高强度聚焦超声治疗剖宫产瘢痕妊娠临床分析

目的 探讨高强度聚焦超声治疗剖宫产瘢痕妊娠的临床价值。方法 2015年6月～2016年4月对15例确诊为剖宫产瘢痕部位妊娠患者给予高强度聚焦超声治疗,术后针对病灶突向宫腔者行宫腔镜电切术或B超监测下清宫术。观察手术时间、病灶血供变化、血β-hCG下降情况、月经复潮等指标。结果 15例患者均一次性完成治疗,手术时间15min～97min(平均52.9min)。术后超声造影对比术前均提示病灶及其周边血流信号明显减少且复查血β-HCG均呈不同程度下降。其中7例于高强度聚焦超声治疗后行宫腔镜妊娠病灶电切术,术中失血2～50ml(平均15ml);1例行B超监测下清宫术,失血10ml,均一次性成功清除胚胎组织,血β-hCG恢复正常时间(23.9±6.1)天,月经恢复时间为(31.4±4.7)天。其余7例因病灶突向浆膜层而未行清宫术,血β-hCG恢复正常时间为(31.8±7.5)天,月经恢复时间为(43.9±10.4)天。15例患者术后随访3个月,均无其他并发症发生。结论 高强度聚焦超声治疗剖宫产瘢痕部位妊娠安全有效且微创。     

高强度聚焦超声治疗子宫肌瘤后妊娠7例分析

对我科2003—08～2004—06采用HIFVNIT-9000(3型超声刀治疗子宫肌瘤术后0．5a内妊娠7例，分析如下。     

高强度聚焦超声治疗子宫腺肌瘤的初步临床观察

目的探讨高强度聚焦超声(HIFU)治疗子宫腺肌瘤的有效性和可行性.方法对10例临床确诊为子宫腺肌瘤的已婚女性患者进行HIFU治疗,治疗后观察病变部位回声、腺肌瘤大小及血流变化,了解患者痛经程度和月经量变化.结果HIFU治疗后,10例患者子宫腺肌瘤病灶回声增强、血流减少,月经量减少,部分痛经改善.结论HIFU治疗子宫腺肌瘤是一种有效、可行、安全的新方法,有进一步研究价值.     

超声介入联合高强度聚焦超声治疗瘢痕妊娠

目的 观察超声介入联合高强度聚焦超声（HIFU）治疗瘢痕妊娠的效果。方法 纳入130例瘢痕妊娠患者,随机分为HIFU组、联合组,每组65例,HIFU组予HIFU治疗,联合组予超声介入MTX联合HIFU治疗。对比治疗前后组间包块大小、视觉模拟评分法（VAS）评分、实验室检查结果、超声参数及妊娠结局等差异。绘制受试者工作特征（ROC）曲线,并计算曲线下面积（AUC）评价治疗后β-人绒毛膜促性腺激素（β-HCG）、妊娠组织直径及瘢痕部位肌壁厚度预测妊娠结局的效能。结果 治疗前,2组间各指标差异均无统计学意义（P均>0.05）。治疗后,联合组包块大小、血清β-HCG、超敏C反应蛋白（hs-CRP）、白细胞介素-8（IL-8）、白细胞介素-17（IL-17）、氧化型低密度脂蛋白（OX-LDL）及血流指数（FI）、搏动指数（PI）、血管化指数（VI）均低于HIFU组（P均<0.05）,血清谷胱甘肽过氧化物酶（GSH-Px）及过氧化氢酶（CAT）均高于HIFU组（P均<0.05）;联合组β-HCG恢复正常时间、月经恢复时间均明显短于HIFU组（P均<0.05）;联合组VAS评分低于HIFU组（P<0.05）;联合组自然分娩率高于HIFU组（P<0.05）,提前终止妊娠率低于HIFU组（P<0.05）。2组内各指标治疗后与治疗前比较差异均有统计学意义（P均<0.05）。MTX治疗后血清β-HCG水平、妊娠组织直径、瘢痕部位肌壁厚度预测瘢痕妊娠结局的AUC分别为0.72、0.65及0.75。结论 超声介入MTX联合HIFU治疗可明显改善瘢痕妊娠患者β-HCG、疼痛程度、减轻炎症反应及氧化应激反应、改善病灶血供,使患者恢复情况、妊娠结局更加理想。     

剖宫产疤痕部位妊娠经阴道彩色多普勒超声图像特征分析

目的探讨剖宫产疤痕部位妊娠（CSP）经阴道彩色多普勒超声检查的声像图特征。方法对14例剖宫产疤痕部位妊娠病例的超声图像进行回顾性分析。结果14例患者超声图像表现为子宫前壁下段剖宫产切口疤痕处肌层缺损或中断,局部探及1.6~5.3 cm的妊娠物包块,包块表现为高回声型7例（占50.00%）,无回声型4例（占28.57%）,孕囊型3例（占21.43%）。彩色多普勒显示包块周围见环状彩色血流或局部血供增多,呈高速低阻型频谱。结论剖宫产疤痕部位妊娠具有特征性的声图像表现,经阴道彩色多普勒超声能早期、准确地诊断剖宫产疤痕部位妊娠。     

双侧子宫动脉化疗栓塞术治疗剖宫产子宫切口妊娠

目的探讨双侧子宫动脉化疗栓塞术治疗剖宫产子宫切口妊娠的临床应用价值。方法 2004年3月2009年10月确诊剖宫产子宫切口妊娠的患者25例。首先行双侧子宫动脉超选择插管,注入甲氨喋岭,再用明胶海绵条栓塞双侧子宫动脉,48～72h内在B型超声监测下行清宫术。结果 25例子宫动脉化疗栓塞术后复查B型超声,提示孕囊血供明显减少。22例在B型超声监测下一次性清除胚胎组织,出血量少;2例因胚胎植入肌层突向浆膜层栓塞术后加用氟尿嘧啶,未行清宫,自行排出;1例因术后切口处形成大血肿行手术治疗。结论双侧子宫动脉化疗栓塞术是治疗剖宫产子宫切口妊娠一种有效方法,既保留子宫,又保留其生育功能。     

彩色多普勒超声诊断剖宫产术后子宫瘢痕妊娠的价值

[目的] 评价彩色多普勒超声在诊断剖宫产术后子宫瘢痕妊娠中的价值.[方法] 11例子宫下段瘢痕妊娠患者,采用经腹经腔内联合彩超检查,观察孕囊位置,妊娠物与子宫切口处肌层的回声、血流分布及两者的分界、宫腔宫颈情况等.[ 结果] 所有患者在宫腔正常部位未见到孕囊.孕囊或包块着床于子宫下段切口肌层处,根据其超声图像表现分为2种类型：①孕囊型2例,②流产包块型9例.[ 结论] 经腹经腔内彩超对剖宫产术后子宫下段瘢痕妊娠的早期诊断有着重要作用.     

Cesarean Scar Pregnancy: Comparing the Efficacy and Tolerability of Treatment with High-Intensity Focused Ultrasound and Uterine Artery Embolization

The aim of this study was to investigate the clinical efficacy of high-intensity focused ultrasound (HIFU) for the treatment of a cesarean scar pregnancy compared with uterine artery embolization (UAE) and intra-arterial methotrexate infusion combined with uterine curettage. In this retrospective cohort study, 31 patients were treated with HIFU (HIFU group), and 45 patients were treated with UAE (UAE group). We compared the treatment and recovery of the patients, including follow-up. After UAE treatment, serum levels of the β subunit of human chorionic gonadotropin declined significantly on the first day, and the residual lesions disappeared in 3–17 wk. One patient underwent hysterectomy; intrauterine adhesions were found by hysteroscopic examination after 6 mo in 2 patients, whose menstrual function did not return to normal. The remainder of the 42 patients recovered normal menstrual functioning during the 3- to 18-wk follow-up. In the patients who underwent HIFU treatment, serum β-HCG levels did not decline rapidly; serum β-HCG levels increased in many patients and then declined to normal steadily within 2–12 wk. Lesions detached in 3–14 wk in all patients, and menstrual functioning was recovered in 3–9 wk without uterine curettage. Compared with the UAE group, the HIFU group had less pain and fewer complications; the patients in the HIFU group were not hospitalized or anesthetized and had lower costs. HIFU is an efficient, tolerable and non-invasive treatment.     

剖宫产术后子宫疤痕处妊娠29例超声诊断

目的:探讨超声在剖宫产术后子宫瘢痕处妊娠的诊断与随访中的临床应用价值.方法:回顾性分析2006年7月至2011年7月诊断的剖宫产术后子宫瘢痕妊娠患者29例的临床资料.结果:29例中,超声检出妊娠囊型18例(1例误诊为正常宫内孕囊),包块型10例(2例误诊为不全流产),破裂型l例.结论:超声对剖宫产术后子宫瘢痕妊娠的诊断简便安全,结果可靠.     

Treatment with Focused Ultrasound Waves Softens the Rat Cervix During Pregnancy

Application of focused ultrasound stimulation (FUS) to the rat cervix during pregnancy has significant physiologic effects. One-millisecond-long pulses of 680-kHz ultrasound with a repetition frequency of 25 Hz, at I_SPTA (spatial-peak, temporal-average intensity) of 1, 2 and 4W/cm², were applied to the rat abdomen over the cervix. FUS produced a significant change in cervical elasticity known as softening, which is part of the ripening process, comparable to the degree seen just before delivery. Timed-pregnant Sprague-Dawley rats (n = 40) were used. During gestation, the FUS system was applied to the cervix for variable times up to 1 h. Daily measurements of cervix light-induced florescence were made to estimate changes in softening. In addition, cervical stretch estimates of softening were made of isolated cervices of control and FUS-treated rats to measure distensiblity. The ultrasound power with I_SPPA (spatial-peak, pulse-average intensity) of 40 W/cm² was considered tolerable; the U.S. Food and Drug Administration regulatory limit is 190 W/cm² for both the body periphery and the fetus. This is the first report of alterations induced by ultrasound in the connective tissue of the cervix and suggests the therapeutic application of ultrasound for the facilitation of labor and delivery.     

Point-of-Care Ultrasound Diagnosis of Cesarean Scar Ectopic Pregnancy: A Case Series

BackgroundA cesarean scar pregnancy (CSP) is a clinically important form of ectopic pregnancy that carries a high risk of maternal morbidity and mortality. As the rate of cesarean sections has risen, this diagnosis is becoming an increasingly important consideration for providers caring for patients in early pregnancy.Case ReportWe present three cases of CSPs in which point-of-care ultrasound expedited the diagnosis and treatment in the emergency department.Why Should an Emergency Physician Be Aware of This?Given the risks of an undiagnosed CSP, the increasing incidence of CSP, and the number of effective treatment options available in early gestation, the prompt and accurate diagnosis of CSP remains crucial to its successful management. As such, it is an important diagnosis for the emergency physician to consider when evaluating a patient in early pregnancy.     

Cesarean Scar Pregnancy

A cesarean scar (ectopic) pregnancy occurs when a pregnancy implants on a cesarean scar. This condition is an uncommon but potentially devastating occurrence. The incidence is increasing as cesarean deliveries become more common. Early recognition of the salient sonographic findings is critical because a delay can lead to increased maternal morbidity and mortality. Magnetic resonance imaging is a valuable troubleshooting tool when sonography is equivocal or inconclusive before therapy or intervention. Early diagnosis by sonography directs therapy and improves outcomes by allowing preservation of the uterus and future fertility. We review the imaging features, differential diagnosis, complications, and treatment of cesarean scar pregnancies in the first trimester.