| Objectives:Based on the clinical efficacy of different surgical methods and the changes of b-hcg in patients with cesarean section scar pregnancy(CSP),the indications of different treatment methods were discussed to guide clinical work and provide reference basis for clinical diagnosis and treatment of scar pregnancy.Methods:From July 2013 to July 2018,181 patients who were hospitalized in the second affiliated hospital of Kunming medical university and Kunming maternal and child health hospital and were diagnosed with CSP were collected as research objects,and their clinical data were analyzed retrospectively.Patients were divided into group A:42 cases of mifepristone and misoprostol oral administration+MTX pretreatment+uterine clearance:group B:60 cases of uterine clearance under hysteroscopy;Group C:85 cases of uterine artery embolization and uterine clearance.Patients in each group were divided into two groups for further analysis and discussion by using the treatment method:the thickness of the muscularis 3mm at the place where the pregnancy sac is the thinnest from the serosal layer of uterus and the thickness of the muscularis 3mm at the place where the pregnancy sac is the thinnest from the serosal layer of uterus and the thickness of>3mm.Statistics of three groups of patients with general situation,including the patient’s age,menopause time,abortion times,cesarean delivery times,distance last cesarean delivery time(years),embryo sac and uterine serosa layer thin muscle layer thickness(mm),the most by preoperative β-hCG,β-hCG within 72 hours after it is concluded that,preoperative and postoperative β-hCG within 48-72-h decline(%),blood loss,when the operation in hospital number of days to evaluate effect of different treatments.Results:1.The comparison of treatment among the three groups showed that the P values of intraoperative bleeding(ml),preoperative and postoperative decline ofβ-hcg(%)and length of stay were all p<0.05,and the difference was statistically significant.Among the three treatment methods,group A had 76.53±124.83ml of intraoperative bleeding,which was the most in the three groups,and 7.12±3.71 days of hospitalization,which was the longest in the three groups.In group B,the intraoperative blood loss was 49.91±128.73ml,and the length of stay was 4.83±1.95,which was the shortest among the three groups.The amount of intraoperative blood loss in group C was 38.04±96.95ml,the lowest among the three groups,and the length of hospital stay was 6.63±2.96 days.The reduction rate of β-hCG in group A was 84±10%,the lowest among the three groups.The reduction rate of β-hCG in group B was 86±8%.The decrease rate of β-hCG in group C was 88 11%,which was the highest among the three groups.2.In the comparison of curative effect between the cases with the thickness of muscular layer 3mm at the thinnest part of the pregnant cyst from the serosal layer of uterus and the cases with the thickness of muscular layer 3mm at the thinnest part of the pregnant cyst from the serosal layer of uterus and the cases with the thickness of>3mm,the treatment effect of the same treatment method on the cases with the thickness of muscular layer 3mm at the thinnest part of the pregnant cyst from the serosal layer of uterus has no significant difference(P>0.05).3.In the cases with fetal heart beat,there were statistically significant differences in intraoperative blood loss,preoperative and postoperative-hcg reduction rate(%)and length of stay between the three treatments(P<0.05),the decline rate(%)of-hcg in group A before and within 72h after surgery was 92.8±5.1,which was the highest among the three groups.The hospitalization days in group B were 4.8±1.3,which was the lowest among the three groups.The intraoperative blood loss of group A was 105.3±166.1ml,which was the highest among the three groups.The intraoperative blood loss of group C was 19.2±22.1ml,which was the lowest among the three groups.Conclusion:1.Drug preconditioning+uterine debridement,hysteroscopic debridement and UAE+uterine debridement in the treatment of postoperative scar pregnancy after cesarean section are effective and desirable,and the patient’s condition and hospital treatment conditions should be considered in a comprehensive way2.Among the three treatment methods,the amount of intraoperative blood loss and the number of days in hospital were more than those of the other two methods in the pretreatment+uterine clearance,and the decline rate of-hcg was the lowest within 48-72h after surgery,with statistically significant differences(P<0).05),indicating that among the three treatment methods,the treatment effect of drug pretreatment+uterine clearance is not as good as that of hysteroscopy and UAE+uterine clearance,which is not recommended as the preferred treatment.3.Among the three treatment methods,hysteroscopic hysterectomy had the shortest hospitalization time(P<0.05),decreased rate of-hcg within 48-72h after surgery(P<0.05)and moderate intraoperative blood loss(P<0.05),can be used as the first choice to shorten the length of hospital stay.4.Among the three treatment methods,UAE+uterine clearance was superior to the other two groups,and the differences were statistically significant(P<0.05),in a comprehensive view,UAE+palace clearance is the best of the three treatment methods,there are interventional treatment conditions of the hospital should give priority to choose UAE for CSP treatment.5.There was no significant difference in the effect of the same treatment method on the cases with the thickness of the muscularis 3mm at the thinnest part of the pregnancy sac from the serosal layer of the uterus and the thickness of>3mm(P>0.05).In the treatment of CSP,the thickness of the muscle layer at the thinnest place between the pregnancy sac and the serosal layer of the uterus can be used as a reference index but not a decisive one.6.For CSP patients with fetal heart beat,drug pretreatment+uterine clearance is not recommended,and UAE+uterine clearance is preferred. |
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