High-intensity focused ultrasound treatment of placenta accreta after vaginal delivery: a preliminary study
High-intensity focused ultrasound treatment of placenta accreta after vaginal delivery: a preliminary study
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DOI：
10.1002/uog.14867
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发表时间：
2016-04-01
影响因子：
7.1
通讯作者：
Qi, H.
中科院分区：
文献类型：
--
作者：
Bai, Y.;Luo, X.;Qi, H.
目的 评价高强度聚焦超声（HIFU）治疗阴道产后植入性胎盘的安全性和有效性。方法 纳入2011年9月至2013年9月期间经阴道分娩诊断为植入性胎盘且生命体征平稳的12例患者。所有患者均使用超声引导的 HIFU 治疗系统进行治疗。作为治疗有效性的指标，我们考虑了彩色多普勒成像上血管指数的降低、通过三维超声和虚拟器官计算机辅助分析评估的残留胎盘尺寸与治疗前相比的尺寸减小、磁共振成像信号强度和增强程度的降低以及治疗后避免子宫切除术。为了评估 HIFU 治疗的安全性，我们记录了副作用、出血、感染、性类固醇水平、月经恢复和随后的怀孕。本初步研究对患者进行随访直至2013年12月。结果接受HIFU治疗的12例患者平均产后住院时间为6.8天，平均残余胎盘复旧期为36.9天。 HIFU 治疗并没有明显增加感染或出血的风险，并且没有患者需要子宫切除术。所有患者平均在 80.2 天后重新开始月经，第二个月经周期黄体中期的性类固醇水平正常。两名患者在随访期间再次怀孕。结论本初步研究表明，超声引导下HIFU是一种安全有效的无创治疗阴道分娩后生命体征稳定且希望保留生育能力的植入性胎盘患者的方法。版权所有 (C) 2015 ISUOG。由约翰·威利父子有限公司出版
Objective To evaluate the safety and efficiency of high-intensity focused ultrasound (HIFU) in the treatment of placenta accreta after vaginal delivery.Methods Enrolled into this study between September 2011 and September 2013 were 12 patients who had been diagnosed with placenta accreta following vaginal delivery and who had stable vital signs. All patients were treated using an ultrasound-guided HIFU treatment system. As indication of the effectiveness of the treatment we considered decreased vascular index on color Doppler imaging, decrease in size of residual placenta compared with pretreatment size on assessment by three-dimensional ultrasound with Virtual Organ Computer-aided Analysis, reduced signal intensity and degree of enhancement on magnetic resonance imaging and avoidance of hysterectomy following treatment. To assess the safety of HIFU treatment, we recorded side effects, hemorrhage, infection, sex steroid levels, return of menses and subsequent pregnancy. Patients were followed up in this preliminary study until December 2013.Results The 12 patients receiving HIFU treatment had an average postpartum hospital stay of 6.8 days and an average period of residual placental involution of 36.9 days. HIFU treatment did not apparently increase the risk of infection or hemorrhage and no patient required hysterectomy. In all patients menstruation recommenced after an average of 80.2 days, and sex steroid levels during the middle luteal phase of the second menstrual cycle were normal. Two patients became pregnant again during the follow-up period.Conclusion This preliminary study suggests that ultrasound-guided HIFU is a safe and effective noninvasive method to treat placenta accreta patients after vaginal delivery who have stable vital signs and desire to preserve fertility. Copyright (C) 2015 ISUOG. Published by John Wiley & Sons Ltd.