The Efficacy Analysis Of Different Approaches To The Treatment Of Cesarean Scar Pregnancy

Objective：Explore the treatment method and efficacy of the cesarean scarpregnancy.Methods:Collect88cases of cesarean scar pregnancy (CSP) patients from theSecond Clinical Hospital of Jilin University from January2007to December2012. According to the different treatment methods are divided into3groups:Group A: conservative operation group58cases (medicine pretreatment+pregnancy tissue clearance operation under the application of hysteroscopic);Group B: uterine artery embolization+pregnancy tissue clearance operationunder the application of hysteroscopic21cases; Group C: laparotomy group(Lesion resection or hysterectomy)9cases. Compare and analyse everythingfrom the preoperative situation (General of patients)、 surgery (bleeding,surgery time, Uterine distention fluid dosage, Uterine distention fluid absorbeddose)、 postoperative recovery (β-hCG restored to normal time, menstruationrestored to normal time, vaginal bleeding time)、the success rate of treatment、the hospitalization time and cost in order to seek a more reasonable, safe,effective treatment method.Results:1．A comparison of the situation during operation: the blood loss ofmedicine pretreatment+pregnancy tissue clearance operation under theapplication of hysteroscopic、uterine artery embolization+pregnancy tissueclearance operation under the application of hysteroscopic and laparotomy group was respectively30.77±17.68ml、140.59±33.05ml、355.55±149.50ml,Comparison between groups of data was statistical significance. Operation timeof patients in the three groups was18.23±5.08min,26.35±5.84min,43.56±5.34min, there was significant statistical difference between groups data(P<0.01). The dose of uterine distention fluid of groud A and B was respectively2656.25±573.72ml、3247.12±551.27ml, There was significant statisticaldifference (P<0.01). The dose of uterine distention fluid absorbed was166±32.38ml、252.94±52.77ml, there was significant statistical differencebetween the two groups data (P<0.01).2．A comparison of the condition of postoperative recovery：β-hCGrecovery time among A,B,C groups wsa respectively34.35±14.83d,35.45±12.93d,9.67±4.0d, there was significant statisticaldifference between C and the first two groups（P<0.01）,but there was notstatistical difference between A and B（P>0.05）; Menstrual recovery time wasrespectively33.87±6.36d、30.71±6.14d、35.00±5.59d, there was not statisticaldifference（P>0.05）. Vaginal bleeding time was respectively24.28±4.34d、32.64±6.19d、19.33±6.87d, there was statistical difference（P<0.05）.3. Comparison of hospital length of stay and hospital costs: length ofhospital stay was respectively8.07±3.19d、22.35±6.57d，5.77±1.09d, there wasstatistical difference （P<0.05）; hospital costs were respectively8815.05±1249.18yuan、20788.95±4684.96yuan、6216.49±2081.27yuan, therewas statistical difference（P<0.05）.4. Comparative success rate: The success rate was respectively94.8%,100%,100%, there was not statistical difference（P>0.05）.Conclusions:1. Medicine pretreatment+pregnancy tissue clearance operation under theapplication of hysteroscopic,uterine artery embolization+pregnancy tissue clearance operation under the application of hysteroscopic and laparotomy areall the effective methods. These methods all have a good success rate,but thefirst two methods can reduce the damage, avoid hysterectomy, reservereproductive function for patients.2. Medicine pretreatment+pregnancy tissue clearance operation under theapplication of hysteroscopic,uterine artery embolization+pregnancy tissueclearance operation under the application of hysteroscopic have all achievedgood effect, but the former have shorter hospitalization time, lower costs andlighter injury.