The Clinical Analysis Of Mifepristone And UAE Respectively Combined With Hysteroscopic Uterus Curettage In The Treatment Of Type Ⅱ CSP

Objects:To compare the clinical efficacy of mifepristone and Uterine Artery Embolization（UAE）respectively combined with hysteroscopic uterus curettage in the treatment of type II Cesarean Scar Pregnancy（CSP）,and evaluate the clinical value and application prospect.Methods:A total of 128 cases of type II CSP were analyzed,and they were all treated in our hospital from December 2017 to December 2020.They were divided into two groups according to different treatment methods,and each group was divided into two subgroups according to the limit of lesion diameter of 3cm.Drug group:mifepristone+hysteroscopic uterus curettage（56 cases）;Embolization group:UAE+hysteroscopic uterus curettage（72 cases）.The preoperative basic information,intraoperative and postoperative conditions,related complications,follow-up situation,changes in ovarian function before and 3 months after treatment were compared,and the treatment efficiency of each group was further analyzed.The data was analyzed by statistical methods.Results:1.There were no statistical differences in preoperative basic conditions between the two groups,such as age,gestational number,total number of cesarean sections,interval time from the previous operation,days of menopause,diameter line of the lesion,thickness of scar muscle,and serum h CG value before treatment（P>0.05）.2.Intraoperative and postoperative conditions:In terms of intraoperative blood loss,hospitalization cost,length of stay,menstrual recovery and postoperative vaginal bleeding time,the embolization group significantly reduced the intraoperative blood loss（P<0.01）,while the drug group needed less hospitalization cost（P<0.01）,and the length of hospital stay,menstrual recovery and postoperative vaginal bleeding time were shorter（P<0.01）.There was no significant difference in operation time and serum h CG recovery time between the two groups（P>0.05）.3.Comparison of treatment effective rate:Comparison between groups:there was no statistical difference between the two groups（P>0.05）.Comparison within the groups:the treatment success rates of patients with lesion diameter≤3cm and lesion diameter>3cm were 96.4%and 82.1%respectively in the drug group;the treatment success rates with lesion diameter≤3cm and lesion diameter>3cm were 94.3%and81.1%respectively in the embolization group.Although there was no statistical difference（P>0.05）,the success rate of treatment was still high in patients with lesion diameter≤3cm.4.Comparison of postoperative complications:Compared with the drug group,the incidence of postoperative fever and severe pain was higher in the embolization group（P<0.05）;The gastrointestinal discomfort in drug group was more significant（P<0.05）.There was no significant difference between the two groups in liver function damage and postoperative embolization of other organs（P>0.05）,but pulmonary embolism was found in 1 patient in the embolization group.5.Follow-up postoperative:Compared with the drug group,the embolization group was more prone to menstrual changes and intrauterine adhesion after surgery,with statistical differences（P<0.05）.6.Comparison of ovarian function:Comparison of the drug group before and after treatment:there was no statistical difference in ovarian function before and after treatment（P>0.05）.Comparison before and after treatment in the embolization group:the levels of serum FSH,LH and E₂in the embolization group after treatment increased compared with those before treatment,and there was no statistical difference（P>0.05）;the levels of serum AMH and the antral follicle count in bilateral ovaries decreased significantly after treatment（P<0.05）.Comparison between the two groups after treatment:the embolization group had higher levels of serum FSH,LH,and E₂,but there were no statistically significant differences（P>0.05）;the levels of serum AMH and the antral follicle count in bilateral ovaries were lower in the embolization group（P<0.05）.Conclusions:1.Mifepristone combined with hysteroscopic uterus curettage is the preferred method of clinical treatment for type II CSP patients,and the clinical efficacy is better when the diameter of lesions≤3cm;2.Mifepristone combined with hysteroscopic uterus curettage has the advantages of low cost,fewer complications and quick postoperative recovery.Although intraoperative bleeding is relatively more,it is still within the safe range and worthy of clinical promotion;3.The application of UAE can reduce the amount of intraoperative blood loss,but its cost is high,postoperative complications are more,menstrual recovery is slow,and the ovarian function of childbearing age is affected in the short term,so it is not recommended as a conventional treatment for type II CSP.