| Objective To Analyze the application value of laparoscopy combined uterine artery embolization(UAE)for the treatment of exogenous cesarean scar pregnancy.Methods Retrospectively analyzed the clinical manifestations,diagnosis,therapeutic methods and curative effect of the 31 cases of exogenous cesarean scar pregnancy treated with laparoscopy combined uterine artery embolization admitted in Beijing Military General Hospital from January 2010 to January 2016.Results The average age of all enrolled patients was 33.9±5.3 years(range: 23~44).Their average gravidity was 3.9±1.7(range: 2~9),and their average parity was 1.3±0.5(range: 1~2).The times of induced abortion were between 0 and 4.Their average time of cesarean section was 1.3±0.5(range:1~2 times),of these patients,22 had undergone one cesarean section,and 9 had undergone two cesarean sections.The average time from their last cesarean section was 4.6±3.2 years(range: 0.5~13 years).The 31 cases all had the history of menopause,the average menolipsis period was 62.4±20.2 days(range: 38~120 days).Of the 31 patients,12 presented with vaginal bleeding,one reported abdominal pain and 9 reported vaginal bleeding with abdominal pain while 9 were asymptomatic.Of the 31 patients,5 patients(5/31)were misdiagnosed as uterine pregnancy and had been given artificial abortion?medical abortion ? suction curettage and so on at their first visit to other hospitals,postoperatively presenting with vaginal irregular bleeding or the ultrasonic examination anomalies?a consistent abnormal HCG,and transferred to our hospital.Gynecological examination:the 31 patients were all found that uteruses enlarged in different degrees with or without tenderness(+),with or without a small amount of vaginal bleeding,bilateral adnexa were not touched obvious abnormally.Just one patient in the gynecological examination of this time was discoveried that the cervix was mild hyperemia,the cervix of the uterus lifts the pain and cervical motion tenderness who once had artificial abortion in other hospital.The 31 patients were all primarily diagnosed by ultrasound examination of department of gynaecology.Of the 31 patients,18 cases of ultrasound examination represented gestational sac,the lower segment of uterine and cesarean section incision of others could manifested slightly hyperechoic or non-homogeneousl echo.In the ultrasonic examination,9 cases represented yolk sac,5 cases were visible of fetal heart and embryonic bud,1 case was visible of embryonic bud without fetal heart beat and 19 cases were seen rich blood supply signals.1 case of ultrasound examination suggested a dichorionic and diamnionic twin pregnancy,and were all planted in the cesarean section scar incision.1 case of ultrasound examination suggested the bladder wall abnormal considering the gestational sac had invaded the bladder wall.Of the 31 cases,8 cases underwent MRI because of ultrasonographic outcomes were unclear or needed to make clear other related matters(for example,the diagnosis and classification of CSP,making sure whether the lesions invaded myometrium and the depth of invaded-myometrium,and making sure whether the lesions invaded neighbor organs and so on),the reasons were:of the ultrasonographic outcomes,2 cases suggested the possibility of CSP;1 case presented the lower edge of gestational sac was close to cesarean section incision suggesting not excluding CSP;1 case suspected to cervical pregnancy;3 cases there was doubt about the classification of CSP;1 case suspected to have invaded the bladder.The MRI outcomes of above 8 cases all suggested exogenous CSP whose postoperative pathology all confirmed CSP.The serum ?-hCG level increased in varying degrees(range: 70.6~47635.0mU/L),Of the 31 patients,30 patients had been given UAE,then after 0.5~48.0h had laparoscopic scar lesion resection.The left one patient had laparoscopic scar lesion resection directly without UAE preoperatively because of the lower serum ?-hCG level before operation.30 cases of laparoscopic treatment ended up with success at once who were operated UAE before the operation,the blood HCG test results of postoperative 2 ~ 5 d is 551.1 ~ 5495.4mU/L with an average of(2180.7±763.9)mU/L,on average lower by(89.5%±8.2%)comparing with the preoperative HCG test results.1 case of patient who suffered massive hemorrhage transfered emergency transfusions +laparotomy scar lesion resection + uterine artery embolization who was not operated UAE before the operation.31 patients all were cured out of the hospital and none of re-admission.A postoperative ultrasonographic evaluation was performed for the 31 patients at regular intervals after the surgery.The ultrasonic outcome had completely returned to normal by the end of the 28 th day of follow-up.In the followed patients,the recovery period of normal menstruation was 36 to 92 days with a average of 68 days.Of the followed patients,there are 5 patients who had intrauterine early pregnancy and underwent induced abortion again,2 patients had tubal ectopic pregnancy,no case of recurrence of CSP.Conclusion1.Uterine artery embolization combined surgical treatment were used for the treatment of CSP,preoperative application of UAE can reduce bleeding in operation,intraoperative application of UAE can effectively control the bleeding.In general 24 to 48 hours after UAE,surgical treatment effect is better.2.Laparoscopic surgery can retain the reproductive function of patients with small trauma and quick recovery,but it require higher operating technology.3.Laparoscopy combined uterine artery embolization(UAE)for the treatment of exogenous cesarean scar pregnancy is intuitive,safe,effective comparing others treatments.4.But the end of long-term pregnancy for the postoperative patients of laparoscopy combined uterine artery embolization(UAE)still lack of sufficient data. |
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