| Objective: To analyze the clinical characteristics of CSP;Compare the efficacy of two treatment methods: method1 Laparoscopic Uterine Artery Occlusion + Laparoscopic surgery suction curettage,method2 Interventional uterine artery embolization + Ultrasound guided suction curettage;The factors that may affect the effectiveness of CSP were analyzed to guide the treatment of CSP patients.Method: CSP patients who underwent these two methods from August 2015 to December 2016 at the First Affiliated Hospital of Soochow University were enrolled.There were 14 cases of CSP patients treated with Laparoscopic Uterine Artery Occlusion +Laparoscopic surgery suction curettage.There were 51 cases of CSP patients treated with Interventional uterine artery embolization + Ultrasound guided suction curettage.Preoperative general information of patient were collected(Age,number of pregnancies,number of childbirth,number of abortions,number of cesarean delivery times,menopause time,preoperative β-hCG,the average diameter of gestational sac,length of embryo,fetal heartbeat,the thickness of the embryo from the plasma membrane);Blood loss,postoperative β-hCG drops,length of stay,hospital costs were compared;The efficacy of the two approaches were evaluated in the patients by following up of serum β-hCG,Ultrasound and long-term complications after a month.The factors that affect efficacy were explored by Logistic regression analysis of the curative effect of multivariate analysis.Results:1.Genereal information of CSP patients: The age of 65 cases in this study were distributed in 24-44 years old,with an average age of 31.9 + 4.4 years.;The median number of pregnancy was 3 times;The median number of childbirth was 1 times;The median number of abortion was 1 times;The median number of cesarean section was 1times;median time interval of the last cesarean section to the incidence was 5 years.2.CSP clinical manifestations: In 65 cases of CSP patients,14 patients was without any symptoms,accounting for 21.54%;There were 45 cases of bleeding in the vagina after menopause,accounting for 69.23%,of which 32 cases were painless vaginal bleeding,accounting for 49.23% and 13 cases were painful vaginal bleeding,accounting for 20%.6cases were simple abdominal pain,accounting for 9.23%.3.Comparison of the two groups: The age of two groups compared by t test,the times of pregnancy,childbirth,abortion,cesarean delivery and the time interval of the last cesarean section to the incidence compared by the Mann-Whitney U test,P were greater than 0.05 and the difference was not statistically significant.4.Comparison of preoperative conditions :The a menopause time,the average diameter of gestational sac,the thickness of the embryo from the plasma membrane compared by t test,preoperative β-hCG,the average diameter of gestational sac,length of embryo,fetal heartbeat compared by the Mann-Whitney U test,P were greater than 0.05 and the difference was not statistically significant.5.Comparison of intraoperative and postoperative conditions :The changes inβ-hCG were evaluated by Mann-Whitney U test,P > 0.05 and the difference was not statistically significant;The amount of blood in the two groups was measured by Mann-Whitney U test,P < 0.05 and the amount of blood of method 1 was greater than method 2 with statistical significance;Two groups of hospitalized time were examined by t,P < 0.05 and method 1 was greater than method 2 with statistical significance;The two groups of hospitalization expenses were examined by t,P < 0.05,method 1 was less than the method2 with statistical significance;6.Comparison of the efficacy : Methods 1 :In the 14 cases,ultrasound of two patients showed scar site visible echo disorder area,which can be seen within the blood flow signal;1 patient β-hCG has not yet turned negative and the success rate was 78.6%.Methods 2 :Ultrasound of three patients showed scar site visible echo disorder area,which can be seen within the blood flow signal;In one case,a large amount of hemorrhage was performed and the operation was terminated and the blood transfusion was later treated;One patient was rehospitalised after two months because of a continuous bleeding.One patient had cystitis after surgery and was electrovaporized by urethral bladder tumor.The success rate was 88.2%.Two groups of curative effects were examined by χ2 test,P > 0.05 and the two groups were of no statistically significant effect.7.Effect factor: The P of menopause time,number of abortions,preoperative β-hCG,the average diameter of gestational sac,the thickness of the embryo from the plasma membrane was less than 0.05,which was statistically significant.Combined with theregression coefficient can be obtained: the longer the number of days of menopause,the greater the number of abortion,the greater the average diameter of gestational sac,the closer the distance from the serosal capsule from the serrate,the greater the likelihood of surgical failure;The regression coefficient of preoperative β-hCG was 0,which means that the preoperative β-hCG has nothing to do with the efficacy of the operation.conclusion:1.The main clinical manifestation of CSP is the bleeding of the vagina after menopause,mainly to painless vaginal bleeding.Many patients have no clinical manifestations and have been found by routine ultrasonography,so a careful CSP occurs after cesarean section.2.Laparoscopic Uterine Artery Occlusion + Laparoscopic surgery suction curettage is equivalent to Interventional uterine artery embolization + Ultrasound guided suction curettage and it’s more economical;It has low incidence of complications;Treatment does not need to help through other departments and the hospital in the absence of intervention can also be implemented;The treatment process is continuous,and the arterial blockage is feasible.The entire surgical procedure is in total anesthesia,effectively reducing pain and fear in patients.3.The longer the number of days of menopause,the greater the number of abortion,the greater the average diameter of gestational sac,the closer the distance from the serosal capsule from the serrate,the greater the likelihood of surgical failure;The regression coefficient of preoperative β-hCG was 0,which means that the preoperative β-hCG has nothing to do with the efficacy of the operation. |
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