Objective To investigate the safety and efficacy of high-intensity focused ultrasound(HIFU)combined with suction curettage under hysteroscopic guidance for cesarean scar pregnancy(CSP)and to analyze the influencing factors of vaginal bleeding and readmission.Methods From January 2014 to September 2017 in the Third Xiangya Hospital of Central South University,367 patients with cesarean scar pregnancy were treated by HIFU combined with suction curettage under hysteroscopic guidance.All the patients received one session of HIFU ablation. Their clinical data were analyzed and the treatment effect and safety were observed.Results After HIFU treatment,the fetal cardiac activity disappeared and the blood flow around the sac was significantly decreased. The median volume of blood loss in the suction curettage was 20(range 5～600)mL.The volume of vaginal bleeding is related to the largest diameter of the sac,and the risk of large vaginal bleeding of patients was increased with larger diameter of the sac(P=0.015). The risk of readmission is related to the volume of vaginal bleeding,the risk of readmission of patients was increased with larger vaginal bleeding (P=0.000).No serious complication was observed.Conclusion HIFU combined with suction curettage under hysteroscopic guidance is effective in treating patients with CSP of typeⅠ and type Ⅱ.%目的 探讨高强度聚焦超声(HIFU)联合宫腔镜指导下负压吸宫术治疗剖宫产瘢痕妊娠(CSP)的临床效果及影响出血量和再入院的相关因素.方法 回顾性分析2014年1月至2017年9月在中南大学湘雅三医院经HIFU治疗后行宫腔镜指导下负压吸宫术清宫治疗的367例CSP患者,观察治疗的有效性及安全性.结果 HIFU治疗后,孕囊的原始心管搏动消失,孕囊周边血流信号显著减少.吸宫术中中位出血量20(5～600)mL.孕囊最大径是出血量的独立危险因素(P=0.015),孕囊越大,越有可能发生大出血.出血量是患者再次住院的影响因素(P=0.000),出血量越大,越容易再次入院.未发现严重并发症发生.结论 HIFU联合宫腔镜下负压吸宫术治疗Ⅰ型及Ⅱ型CSP有效.
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