Clinical Analysis Of High Intensity Focused Ultrasound In The Treatment Of Cesarean Scar Pregnancy

Objective:To evaluate the clinical efficacy of HIFU in the treatment of CSP.Methods:Collected 25 cases of CSP patients which were diagnosed and treated in the Center Hospital of Suining City from January 2014 to March 2015. All the patients were diagnosed CSP definitely by medical history, clinical manifestations, auxiliary examinations and so on. Among them,21 patients had not received any previous treatment,4 patients received uterine curettage before hospital admission but with persistent bleeding, the blood β-HCG was not decreased significantly.All patients received HIFU treatment under sedative and analgesic, and intravenous drip of oxytocin injection in 5% glucose injection in the meantime. The power was 200-400W, and the average power was 378± 33W. The right time of terminal treatment was decided by the change of ultrasound echo, the color Doppler flow signal and the contrast-enhanced ultrasound of the pregnant tissue. The adverse effects and complications in the treatment were observed.In order to reduce the absorption time of pregnant tissues, among 25 cases with CSP,18 patients were combined with uterine curettage within 2-6 days and the amount of bleeding was noted. The other 7 patients avoided uterine curettage because they had uterine curettage before HIFU treatment or the pregnant tissues were small. The blood β-HCG levels were measured before and at 2、7days after the HIFU treatment respectively, then this data was statistically analyzed.Results:1. The 25 patients were completed with HIFU treatment successfully, and all vital signs were stable. In pregnant bursa peripheral, the ultrasound echo changed significantly, the color Doppler flow signals were reduced and the blood perfusion of tissues reduced significantly after the HIFU treatment.2. After HIFU treatment,18 patients were combined with curettage within 2-6 days, and 7 patients were without. The amount of bleeding of uterine curettage were 10-500ml,85 ± 115.7ml on average, only 1 patients had 500ml blood loss and decreased after using hematischesis medicine.3. There was no statistical significance in the blood β-HCG levels between before and after 2 days HIFU treatment. The blood β-HCG levels at 7 days after HIFU treatment were different from before HIFU significantly (P<0.05)4. After 1-3 months HIFU treatment follow-up, The blood β-HCG levels of 25 patients decreased with the time, and recovered to normal level at the 28±16 days. The 25 patients resumed menstruation after 37±15 days. The duration of vaginal bleeding of 25 patients were 26+21 days.5. In the HIFU treatment,4 patients felt no obvious discomfort,19 patients had a pain in the lower abdomen,13 patients had a pain in the sacral tail, and 6 patients felt hot in the lower abdominal skin, but the pain got better after rest. No case of serious complications occurred such as the injury of bladder, skin burns.Conclusions:1. The coagulative necrosis appeared in the pregnant tissues resulted from the effect of HIFU, so that the lesions can absorbed automatically or create favorable conditions for uterine curettage, reduce the amount of bleeding.2.After 1-3 months HIFU treatment follow-up, The blood β-HCG levels of 25 patients decreased with the time, and recovered to normal level. All patients resumed menstruation and the duration of vaginal bleeding decreased. So HIFU treatment is effective.3.The adverse reactions are well tolerated in the treatment of CSP with HIFU, and without serious complications occurred.