Analysis Of The Effects Of High-intensity Focused Ultrasound Treatment For Cesarean Scar Pregnancy And Its Comparisions With The Other Common Treatments

Part 1 Analysis of the treatment effects of high-intensity focused ultrasound treatment for CSPObjective To explore the treatment effects of HIFU for CSP.Methods 11 patients with CSP who were willing to be treated with HIFU were performed by HIFU followed with suction curettage, the fetal cardiac beat,the level of serum β-HCG and the sonographic outcomes were observed before and after HIFU treatment.The level of serumβ-HCG and RI before and after HIFU treatment were analysed.Results1. The fetal cardiac beats disappeared soon after HIFU treatment in 4 cases with fetal cardiac beat of 11 CSP patients.2. There were not obvious differences between before HIFU treatment and d4 after the treatment in the level of serum β-HCG(P >0.05), while the level of serum β-HCG of d7 after treatment was lower than before treatment and of d4 after treatment as well(P<0.05).3. RI increased 1 week after HIFU treatment(P=0.02).4. During the therapy, there were 7 patients complained of adominal pain, amd 10 patients complained of lower limbs numbness, both of which relieved after the suspension of the operation. 1 patient presented with needling sensation in her right lower limb right after the treatment recovered herself one week after, and another one patient who complained of hematuria recovered from it 24 hours after the treatment.Conclusions HIFU is a new effective treatment for CSP patients, with the advantages of less injuries and complications.Part 2 Comparisons of the clinical effects between HIFU and the other common treatments for CSPObjective The clinical effects of HIFU treatment followed with suction curttage, medication abortion treatment, medication treatment followed with suction curettage, suction curettage,laparoscopic surgery, laparotomy for CSP were compared to each other to evaluate the clinical values of HIFU in treating CSP.Methods The clinical data of 65 patients with CSP who were admitted in the First affiliated Hospital of Jinan University from December 2012 to December 2015 were analyzed retrospectively. According to the patients’ preferred treatments, they were divided into 6 groups including Group A treated with HIFU followed with suction curettage, Group B treated with medication abortion treatment, Group C treated with medication treatment followed with suction curettage, Group D treated with suction curettage only, Group E treated with laparoscopic surgery, Group F treated with laparotomy. The general situations, the examination results, the success rates, the hospitalization expenses, the hospitalization time and the blood loos during the treatment of the 6 groups of patients were analyzed statistically to evaluate the clinical values of HIFU in treating CSP.Results1. There were not significant differences among the 6 groups in the level of serum β-HCG, the thickness of the muscle in the lower uterus segment, the blood flow grade of the CSP lesion and the fetal cardiac beat(P>0.05),while there was a statistical difference in type of CSP among the6 groups(P=0.03).2. There was not a signicant difference in the blood loos among the 6 groups(P>0.05), while there were some differences in the success rate of the treatment, the hopitalization cost and time(P<0.05). Further pairwise comparisons showed that the success rate of the Group A treated by HIFU followed with suction curettage was not different from the Group C treated by medication abortion treatment, Group D treated by suction curettage, Group E treated by laparoscopic surgery and Group F treated by laparotomy(P>0.05), with the lowest success rate of Group B treated by medication abortion treatment(P<0.05). The hospitalization cost of Group A treated by HIFU followed with suction curettage was higher than Group B treatd by medication abortion treatment, Group C treated by medication treatment followed with suction curettage and Group D treated with suction curettage(P<0.05), while it was much the same as the groups treated with laparoscopic surgery and laparotomy(P>0.05). The hospitalization time of Group A treated by HIFU followed with suction curettage was longer than Group B treatd by medication abortion treatment,Group C treated by medication treatment followed with suction curettage and Group D treated with suction curettage(P<0.05), while it was much the same as the groups treated with laparoscopic surgery and laparotomy(P>0.05).Conclusions1. Compared to the medication treatment followed with suction curettage, suction curettage,laparoscopic surgery and laparotomy, HIFU treatment followed with suction curettage doesn’t have more advantages in the success rate, hospitalization cost, hospitalization time, blood loos during treatment of in treating CSP.2. Types of CSP is one of the important references in selecting the treatment for CSP.3. Mifepristone combined with misoprostol in the treatment for CSP is related to high failure rate and high risks of serious complications such as severe vaginal bleeding and uterine rupture.