高强度聚焦超声联合术后清宫治疗胎盘植入的有效性研究
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摘要
目的探讨高强度聚焦超声联合术后清宫治疗胎盘植入的有效性及对患者并发症的影响。方法选择2016年1月～2018年6月重庆医科大学附属大学城医院和重庆医科大学附属第一医院妇产科就诊的60例胎盘植入患者,按照随机数字表法分为对照组和观察组,每组各30例,对照组实施经子宫动脉甲氨蝶呤灌注栓塞联合清宫治疗,观察组实施高强度聚焦超声联合术后清宫治疗,比较两组的术中出血量、术后出血量、一次性清宫成功率、子宫切除率、术后并发症发生率、术后疼痛评分、血清人绒毛膜促性腺激素β(β-HCG)、住院时间、子宫复旧时间、月经恢复时间、免疫功能指标。结果两组一次性清宫成功率比较,差异无统计学意义(P> 0.05),但观察组的术中出血量和术后出血量均低于对照组(P <0.05),其子宫切除率、术后并发症总发生率、术后疼痛评分均低于对照组(P <0.05)。术后,观察组的血清β-HCG低于对照组(P <0.05),血清β-HCG恢复正常时间、住院时间、子宫复旧时间、月经恢复时间均短于对照组(P <0.05)。两组术后CD3~+、CD4~+/CD8~+等指标均较术前降低(P <0.05),而术后观察组的免疫功能各项指标均高于对照组(P <0.05)。结论高强度聚焦超声联合术后清宫治疗可在保证清宫效果的基础上,有效减少患者的出血量、并发症、子宫切除,有利于减轻其术后疼痛感和免疫功能异常,促使患者血清β-HCG、子宫、月经等尽快恢复。
Objective To study the effect of high intensity focused ultrasound(HIFU) combined with uterine clearing on placenta accreta and its complications. Methods From January 2016 to June 2018, in University City Hospital Affiliated to Chongqing Medical University and the First Hospital Affiliated to Chongqing Medical University, 60 patients with placenta accreta were selected, according to random number table method, they were divided into control group and observation group, with 30 cases in each group. The control group was treated with transuterine arterial methotrexate embolization combined with uterine clearing, and the observation group was treated with high intensity focused ultrasound combined with postoperative uterine clearing. The blood loss, postoperative blood loss and one-off uterine clearance success rate, the rate of hysterectomy, the incidence of postoperative complications, postoperative pain score,serum human chorionic gonadotropin β(β-HCG), hospitalization time, uterine recovery time, menstrual recovery time,immune function index in the two groups were compared. Results There was no significant difference in the success rate of one-off uterine clearing between the two groups(P > 0.05), but the amount of intraoperative and postoperative bleeding in the observation group was lower than that in the control group(P < 0.05). The hysterectomy rate and the total incidence of postoperative complications in the observation group were lower than those in the control group(P <0.05). The postoperative pain score was lower than that in the control group(P < 0.05). After operation, the serum β-HCG in the observation group was lower than that in the control group(P < 0.05). The recovery time of serum β-HCG,hospitalization time, uterine recovery time and menstrual recovery time in the observation group were shorter than those in the control group(P < 0.05). The indexes of CD3~+and CD4~+/CD8~+in the two groups were lower than those before operation(P < 0.05), but the immune function indexes in the observation group were higher than those in the control group(P < 0.05). Conclusion High intensity focused ultrasound combined with postoperative hysterectomy can effectively reduce the amount of bleeding, complications and hysterectomy of patients on the basis of ensuring the effect of hysterectomy, which is conducive to the reduction of postoperative pain and abnormal immune function, and the prompt recovery of serum betahcg, uterus and menstruation of patients.
Objective To study the effect of high intensity focused ultrasound(HIFU) combined with uterine clearing on placenta accreta and its complications. Methods From January 2016 to June 2018, in University City Hospital Affiliated to Chongqing Medical University and the First Hospital Affiliated to Chongqing Medical University, 60 patients with placenta accreta were selected, according to random number table method, they were divided into control group and observation group, with 30 cases in each group. The control group was treated with transuterine arterial methotrexate embolization combined with uterine clearing, and the observation group was treated with high intensity focused ultrasound combined with postoperative uterine clearing. The blood loss, postoperative blood loss and one-off uterine clearance success rate, the rate of hysterectomy, the incidence of postoperative complications, postoperative pain score,serum human chorionic gonadotropin β(β-HCG), hospitalization time, uterine recovery time, menstrual recovery time,immune function index in the two groups were compared. Results There was no significant difference in the success rate of one-off uterine clearing between the two groups(P > 0.05), but the amount of intraoperative and postoperative bleeding in the observation group was lower than that in the control group(P < 0.05). The hysterectomy rate and the total incidence of postoperative complications in the observation group were lower than those in the control group(P <0.05). The postoperative pain score was lower than that in the control group(P < 0.05). After operation, the serum β-HCG in the observation group was lower than that in the control group(P < 0.05). The recovery time of serum β-HCG,hospitalization time, uterine recovery time and menstrual recovery time in the observation group were shorter than those in the control group(P < 0.05). The indexes of CD3~+and CD4~+/CD8~+in the two groups were lower than those before operation(P < 0.05), but the immune function indexes in the observation group were higher than those in the control group(P < 0.05). Conclusion High intensity focused ultrasound combined with postoperative hysterectomy can effectively reduce the amount of bleeding, complications and hysterectomy of patients on the basis of ensuring the effect of hysterectomy, which is conducive to the reduction of postoperative pain and abnormal immune function, and the prompt recovery of serum betahcg, uterus and menstruation of patients.
引文
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[2]Huang G,Zhou R,Hu Y.A new suture technique for cesarean delivery complicated by hemorrhage in cases of placenta previa accreta[J].Int J Gynaecol Obstet,2014,124(3):262-263.
[3]吴静.彩色多普勒超声诊断胎盘植入的临床价值探讨[J].安徽医学,2016,37(6):754-755.
[4]吴令.超声消融产后胎盘植入的有效性及安全性研究[D].重庆:重庆医科大学,2016.
[5]Sakhavar N,Heidari Z,Mahmoudzadeh-Sagheb H.Cervical inversion as a novel technique for postpartum hemorrhage management during cesarean delivery for placenta previa accreta/increta[J].Int J Gynaecol Obstet,2015,128(2):122-125.
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[7]敬巧,张娟,范波,等.子宫动脉化疗栓塞术治疗完全性胎盘植入的效果[J].中国妇幼保健,2018,33(1):185-188.
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[9]杨慧霞,余琳,时春艳,等.止血带捆绑下子宫下段环形蝶式缝扎术治疗凶险性前置胎盘伴胎盘植入的效果[J].中华围产医学杂志,2015,8(7):497-501.
[10]范波,邵建兰,黄晓萍,等.子宫动脉化疗栓塞在治疗完全性胎盘植入中的应用[J].川北医学院学报,2016,31(6):816-819.
[11]梁秀丽.子宫动脉灌注化疗栓塞术在胎盘植入治疗中的应用[J].河北医药,2014,36(4):521-522.
[12]徐颖媚,刘健玲,向冬梅,等.甲氨蝶呤或子宫动脉灌注栓塞联合清宫术治疗胎盘植入的效果评价[J].中国临床研究,2015,28(2):222-224.
[13]高素娟,刘彬,曹艳敏,等.子宫动脉灌注栓塞治疗胎盘植入的效果及对患者血清VEGF和SFlt-1水平的影响[J].广西医科大学学报,2017,34(9):1299-1302.
[14]陈丽,樊晓君,王莉,等.胎盘植入行经子宫动脉氨甲喋呤灌注、栓塞联合宫腔镜下清宫术的临床分析[J].中国计划生育和妇产科,2016,8(1):45-48.
[15]罗玉辉,任黔川,魏宇,等.宫腔镜下清宫术联合甲氨蝶呤灌注及栓塞治疗胎盘植入的疗效观察[J].中国妇幼健康研究,2017,28(4):469-471.
[16]田虹.经阴道分娩后胎盘植入的高强度聚焦超声治疗进展[J].临床超声医学杂志,2015,17(6):398-400.
[17]付晓敏.高强度聚焦超声治疗产后胎盘植入22例临床研究[D].重庆:重庆医科大学,2014.
[18]王承志.高强度聚焦超声联合清宫术治疗胎盘植入的可行性研究[D].重庆:重庆医科大学,2015.
[19]朱端荣,钱敏,戴雯.甲氨蝶呤联合清宫术治疗剖宫产瘢痕妊娠的效果及对人绒毛膜促性腺激素的影响[J]中国药业,2018,27(9):68-70.
[20]辛丽丽.高强度聚焦超声联合甲氨蝶呤治疗瘢痕妊娠的临床应用[J].中国中西医结合影像学杂志,2018,16(2):207-208.
[21]李娟,干晓琴,林海,等.宫腔镜下清宫术治疗剖宫产瘢痕妊娠前不同预处理方式的疗效分析[J].实用妇产科杂志,2016,32(9):705-708.
[22]张六连,吴闽君.高强度聚焦超声与腹腔镜子宫肌瘤剔除术治疗子宫肌瘤的随机对照研究[J].当代医学,2018,24(28):154-155.
[23]黄流海,黄国华,何佳.高强度聚焦超声在子宫黏膜下肌瘤治疗中的临床效果分析[J].中国医药科学,2017,7(16):68-71.
[24]潘春波.子宫动脉栓塞术联合甲氨蝶呤动脉灌注后清宫治疗瘢痕妊娠的临床价值[J].实用临床医药杂志,2016,20(23):109-110.
[2]Huang G,Zhou R,Hu Y.A new suture technique for cesarean delivery complicated by hemorrhage in cases of placenta previa accreta[J].Int J Gynaecol Obstet,2014,124(3):262-263.
[3]吴静.彩色多普勒超声诊断胎盘植入的临床价值探讨[J].安徽医学,2016,37(6):754-755.
[4]吴令.超声消融产后胎盘植入的有效性及安全性研究[D].重庆:重庆医科大学,2016.
[5]Sakhavar N,Heidari Z,Mahmoudzadeh-Sagheb H.Cervical inversion as a novel technique for postpartum hemorrhage management during cesarean delivery for placenta previa accreta/increta[J].Int J Gynaecol Obstet,2015,128(2):122-125.
[6]刘健玲,向冬梅,徐颖媚,等.产后胎盘植入残留宫内不同疗程药物保守治疗的临床效果[J].中国实用医刊,2016,43(14):83-85.
[7]敬巧,张娟,范波,等.子宫动脉化疗栓塞术治疗完全性胎盘植入的效果[J].中国妇幼保健,2018,33(1):185-188.
[8]Roulot A,Barranger E,Morel O,et al.Two-and three-dimensional power Doppler ultrasound in the follow-up of placenta accreta treated conservatively[J].J Gynecol Obstet Biol Reprod(Paris),2015,44(2):176-183.
[9]杨慧霞,余琳,时春艳,等.止血带捆绑下子宫下段环形蝶式缝扎术治疗凶险性前置胎盘伴胎盘植入的效果[J].中华围产医学杂志,2015,8(7):497-501.
[10]范波,邵建兰,黄晓萍,等.子宫动脉化疗栓塞在治疗完全性胎盘植入中的应用[J].川北医学院学报,2016,31(6):816-819.
[11]梁秀丽.子宫动脉灌注化疗栓塞术在胎盘植入治疗中的应用[J].河北医药,2014,36(4):521-522.
[12]徐颖媚,刘健玲,向冬梅,等.甲氨蝶呤或子宫动脉灌注栓塞联合清宫术治疗胎盘植入的效果评价[J].中国临床研究,2015,28(2):222-224.
[13]高素娟,刘彬,曹艳敏,等.子宫动脉灌注栓塞治疗胎盘植入的效果及对患者血清VEGF和SFlt-1水平的影响[J].广西医科大学学报,2017,34(9):1299-1302.
[14]陈丽,樊晓君,王莉,等.胎盘植入行经子宫动脉氨甲喋呤灌注、栓塞联合宫腔镜下清宫术的临床分析[J].中国计划生育和妇产科,2016,8(1):45-48.
[15]罗玉辉,任黔川,魏宇,等.宫腔镜下清宫术联合甲氨蝶呤灌注及栓塞治疗胎盘植入的疗效观察[J].中国妇幼健康研究,2017,28(4):469-471.
[16]田虹.经阴道分娩后胎盘植入的高强度聚焦超声治疗进展[J].临床超声医学杂志,2015,17(6):398-400.
[17]付晓敏.高强度聚焦超声治疗产后胎盘植入22例临床研究[D].重庆:重庆医科大学,2014.
[18]王承志.高强度聚焦超声联合清宫术治疗胎盘植入的可行性研究[D].重庆:重庆医科大学,2015.
[19]朱端荣,钱敏,戴雯.甲氨蝶呤联合清宫术治疗剖宫产瘢痕妊娠的效果及对人绒毛膜促性腺激素的影响[J]中国药业,2018,27(9):68-70.
[20]辛丽丽.高强度聚焦超声联合甲氨蝶呤治疗瘢痕妊娠的临床应用[J].中国中西医结合影像学杂志,2018,16(2):207-208.
[21]李娟,干晓琴,林海,等.宫腔镜下清宫术治疗剖宫产瘢痕妊娠前不同预处理方式的疗效分析[J].实用妇产科杂志,2016,32(9):705-708.
[22]张六连,吴闽君.高强度聚焦超声与腹腔镜子宫肌瘤剔除术治疗子宫肌瘤的随机对照研究[J].当代医学,2018,24(28):154-155.
[23]黄流海,黄国华,何佳.高强度聚焦超声在子宫黏膜下肌瘤治疗中的临床效果分析[J].中国医药科学,2017,7(16):68-71.
[24]潘春波.子宫动脉栓塞术联合甲氨蝶呤动脉灌注后清宫治疗瘢痕妊娠的临床价值[J].实用临床医药杂志,2016,20(23):109-110.