Analysis Of Clinical Application Of Different Treatment Schemes For TypeⅠCaesarean Scar Pregnancy

Research Purposes To investigate and evaluate the therapeutic effect,clinical value and feasibility of 3 different protocols in the treatment of typeⅠCesarean scar pregnancy(CSP-Ⅰ)after Cesarean section,so as to guide the diagnosis and treatment of typeⅠCSP.Materials and methods 116 cases of typeⅠuterine scar pregnancy after Cesarean section from September 2016 to October 2018 in a hospital were analyzed retrospectively(the criteria for inclusion in this study were gestational age ≤12 weeks,previous Cesarean section history ≥1 times,absence of other serious systemic diseases,absence of major organ dysfunction such as heart,kidney and brain,and imaging evidence supporting type I CSP).After admission,the patients were divided into three groups according to their different characteristics of cases,economic conditions and different conservative surgical methods adopted for fertility requirements:(1)Group A(20 cases): Transvaginal surgery group,arter take mifepristone orally for 3 days,adopt lumbar anesthesia or general anesthesia,transvaginal removed the scar and pregnancy tissue,and repair of uterine defect.(2)Group B(47 cases): UAE(Bilateral Uterine arterial embolization)combined with uterine curettage,arter take mifepristone orally for 3 days,Curettage under the guidance of b-ultrasound under local anesthesia 48 hours after UAE.(3)Group C(49 cases): Curettage group,arter take mifepristone orally for 3 days,Curettage under the guidance of b-ultrasound under local anesthesia.To observe and record the clinical indexes of blood loss,operation time,β-HCG(β-Human Chorionic Gonadotropin)decrease,hospitalization time and hospitalization expenses after operation in three groups,and make statistical analysis.Result The operations in Group A,B and C were successfully completed without vaginal bleeding,uterine perforation and conversion to laparotomy.1.The amount of intraoperative bleeding in Group A,B and C: B < C < A,Group B had the least amount of intraoperative bleeding,Group C had in second place behind Group B,and Group A had the most amount of intraoperative bleeding.There was a significant difference between the three groups(p < 0.05).2.The operation time of Group A,B and C: C < B < A,Group C had the lowest operation time,Group B had the second,Group A had the longest operation time,there was significant difference among the three groups(p < 0.05).3.There was no significant difference in the decrease of β-HCG between Group A,B and c(p > 0.05).All the three treatments could quickly and effectively inactivate the embryo,clear the symptoms and reduce the βlood-HCG.4.The hospitalization days of Group A,B and C:C<A=B,Group C were lower than those of Group A(p < 0.043 < 0.05)and Group B(p < 0.001),the difference was significant.There was no significant difference in hospitalization days between Group A and Group B(p = 0.937 > 0.05).5.The hospitalization expenses of Group A,B and C were: C< A < B,Group C had the lowest hospitalization expenses,Group A had the next lowest hospitalization expenses,Group B had the most expensive hospitalization expenses,and there were significant differences among the three groups The difference was statistically significant(p < 0.05).Conclusion The above three treatment schemes has the advantages of small trauma,quick recovery,safety,feasibility and definite curative effect,can removed the pregnancy tissue Completely.Transvaginal surgery and UAE combined with curettage are suitable for high risk CSP patients.Transvaginal surgery can help to repair uterine scar defects,but the risk of surgical trauma is greater than the other two options.UAE can prevent and control vaginal bleeding However,the possibility of long-term premature ovarian failure,peripheral organ dysfunction and venous thrombosis can not be excluded.The operation time and hospitalization days of these two treatment plans are long,the hospitalization expenses are expensive,and the patients’ economic burden is heavy.Curettage under the guidance of b-ultrasound is the most rapid and economical,less bleeding during the operation,and is especially suitable for type I CSP patients which with thick myometrium between the gestational sac and the bladder,this treatment scheme can keep the radiotherapy effects and reduce the cost of hospitalization,reduce the financial burden of patients,to avoid over-treatment.In the treatment of type I CSP,curettage under the guidance of b-ultrasound is a safe,effective and economical treatment,and can be the first choice.