The Clinical Diagnosis And Analysis Of Cesarean Section Scar In Pregnancy

ObjectiveFrom the pathogenesis, diagnosis and treatment of cesarean section scar in pregnancy, to explore the value of ultrasound in the diagnosis and treatment for CSP, explore the MTX local injection of conservative treatment, resection of the lesions, uterine artery embolization+MTX perfusion and curettage after UAE four treatment methods in a value in the treatment of cesarean section scar in pregnancy.Methods1、Retrospective analysis of the first affiliated hospital of kunming medical university hospital wards of department of gynaecology in January 2004-December 2014 clinical records of 123 patients with CSP data;2、Retrospective analysis of 123 patients can access to a complete ultrasound examination records of 94 cases of patients with ultrasound examination results;3、Selected from September 2012 to December 2014 were CSP,76 cases of patients, including 18 patients with MTX local injection of conservative treatment, lesion resection+24 cases of scar repair, UAE+MTX24 cases,10 cases of uterine artery embolization combined curettage surgery, to analyze the data of the clinical diagnosis and treatment and prognosis of 76 patients;Results1、Our hospital in January 2004 to December 2014 were treated 123 patients with CSP, among them 2004 to 2009, a total of 13 patients admitted, but each year since 2010 were significant growth, total 110 cases of patients with treated five years.123 cases of patients, in the outer court,10 cases were misdiagnosed pregnancy,2 cases in our hospital and disease misdiagnosed as cervical pregnancy and nourish cells, the rest of the 121 cases of patients were made in our hospital timely, accurate diagnosis of CSP;Our 2 cases misdiagnosed cases, conservative treatment in our hospital drug failure after laparotomy, misdiagnosis lesion resection in patients with cervical pregnancy, misdiagnosis trophocyte diseases patients hysterectomy;The rest of the 121 patients with MTX 34 patients with conservative treatment, lesion resection in patients with 36 cases, lines of UAE+MTX perfusion in patients with 41 cases, lines of uterine artery embolization combined operation in 10 cases, qing have retained the uterus.2^ Belongs to the endogenous type in 99 patients with 61 cases, accounted for about 62%;Belong to the 38cases of exogenous type, accounts for about 38%.Under ultrasound bag piece maximum diameter of 0.58-8.6 cm (3.03+/-1.84 cm) on average, bag piece from the anterior wall of the uterus size film thickness of 0-10 mm (3.29+/-2.64 mm).In patients with endogenous type, with MTX local injection treatment of 18 cases of conservative treatment;The open or laparoscopic resection of the lesions in 123cases;The UAE+MTX treatment of 20 cases;Adopting UEA within three days after surgery in 10 cases of qing.Exogenous type patients, with MTX local injection treatment in 9 cases of conservative treatment;Using open or laparoscopic resection of the lesions,17 cases;The UAE+MTX treatment in 12 cases.3^ Four treatment groups in age, menopause time, time interval, at times, production time, cesarean delivery times, first time blood concentration of beta HCG, etc, P> 0.05, there was no statistically significant difference, the groups have no difference;On the second day after treatment the blood HCG value, scores and uterine artery embolization combined qing obviously better than that of MTX and the UAE+ MTX group, UAE+MTX group is better than that of MTX group, by comparison (P < 0.05, the difference was statistically significant;On the hospitalization days, the surgical hospitalization days the shortest and longest group 1;Set up 4 on hospitalization expenses, and group 1, at least 4 group P< 0.05, the difference was statistically significant;Between groups in the hospital after HCG dropped to normal and menstruation recovery time, group 2 was better than the other three groups, group 3 is better than that of group 1, by comparison, P< 0.05, the difference was statistically significant.ConclusionsIn recent years, there is an upward trend in the onset of CSP. Combined application of abdominal and vaginal ultrasound is the first choice for CSP auxiliary examination.Endogenous or exogenous type CSP should according to patients with specific conditions to select the appropriate treatment.UAE joint qing dynasty palace art as the preferred treatment of ingrown CSP, UAE+MTX or lesion resection Suggestions as exogenous type CSP recommended treatment.MTX conservative treatment, resection of the lesions, UAE+MTX perfusion technique and UAE joint surgery four treatment methods, such as qing if used properly, can achieve good curative effect.