| Background and ObjectiveCesarean scar pregnancy(CSP), a rare ectopic pregnancy, refers to the womenwith a history of cesarean section again during pregnancy, the embryo implantation inprevious cesarean section uterine incision site. Without specific clinical features, ittends to be misdiagnosed or missed diagnosed, hence quenchless uterine bleedingarising from an inappropriate uterine apoxesis, and even threatens life severely.Owing to sparse incidence and insufficient understanding of CSP, a majority ofpatients with massive hemorrhage used to end up with hysterectomy to ultimatelysave their lives, but lost fertility. In recent years, with the increasing rate of cesareansection, the incidence of CSP has been on the rise. Along with the deepeningunderstanding of CSP. more and more reports have been publicized concerning thecause of the disease, mechanism and treatment, the exact etiology of CSP, however,still remains unclear. Although in pace with the advance of ultrasonic technology andthe improvement of the various treatment methods, various treatment measures offertility preservation has basically taken the place of hysterectomy, the reportedtreatment experience and results vary, and there is still a lack of unified and effectivetreatment method. To explore the best treatment of CSP, this research aims atretrospective analysis of the clinical data of113patients with CSP in the recent fiveyears in order to provide preliminary clinical basis for clinicians on CSP treatmentoptions.Materials and Methods1. Materials：Collect the first affiliated hospital of zhengzhou university andjiaozuo maternity and child care in May2008to May2008treated113patients withCSP in hospital as the research object, pregnant bursa type of44cases, mass type of67cases of type2cases of pregnancy. In addition to the type2cases of CSP,111patients with CSP in different types, different treatment group carries on the analysiscomparison, including local injections of methotrexate (methotrexate, MTX group35examples, systemic application of MTX group35cases, interventional group of31cases,10cases of surgical group. Due to the dissatisfaction with the treatment and,thereafter the change of treatment method,3patients initially with topical applicationof MTX change plan, including1case for intervention and2for surgical treatment;Furthermore,6patients with initial systemic treatment with MTX and3withinterventional therapy turn to surgery instead.2. Methods：Carry on the review analysis to the material of the patients, Thelevel of serum β-human chorionic gonadotrophin (HCG) a week after treatment, thetime of HCG normalization were monitored. The vaginal hemorrhage andcomplications, the changes of ultrasonic images were observed. The hospitalizationtime, expenses and cure rate were analyzed. 3. Statistics: Using SPSS13.0to analyze the data, withx±s for measurementdata, chi-square test for comparison of rate, P <0.05for the difference with statisticalsignificance.Results1. It was found the shortest time in serum HCG decreasing, hospitalization, CSPmass disappearance and HCG normalization of patients with surgery. Patients withUAE was the next, significant differences were found compared to patients withMTX systemic treatment (P<0.05).2. The effect of local MTX on patients with gestational sac was superior to thosewith asymmetrical mass (P<0.05).3. The cost of UAE was the highest of all (P<0.05).Conclusion1. The treatment of CSP should be individualized.2. MTX local treatment may be the preferred method for patients withgestational sac.3.UAE may be the preferred method for patients with asymmetrical mass.4. The mass resection combined with uterine repair is a preferred choice for thepatients with invalid conservative treatment.5. For larger lesions, uterine local thinning muscular layer, the lesions clearly tothe bladder, direct the surgical treatment should be considered. |
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