| Objective:Explore the efficacy and safety of hysteroscopic treatment of cesarean scar pregnancy?CSP?,and analyze the advantages and disadvantages of different pretreatment of hysteroscopy by retrospective analysis,so as to give some better guidances for future clinical work.Methods:The research objects were from obstetrics and gynecology of China-Japan union hospital Jilin university and the 1st hospital of Jilin University from October of 2014 to December of 2016.Choose 98 cases whose treatment programs were hysteroscopic.According to the pretreatment of hysteroscopy,these patients were divided into 4 groups.group A: direct hysteroscopy treatment,a total of 13 cases;group B:systemic drug pretreatment + hysteroscopy treatment,a total of 23 cases;group C: local drug pretreatment + hysteroscopy treatment,a total of 31 cases;group D:UAE+hysteroscopy treatment,a total of 31 cases.All the patients in group A and B were Type? CSP.In group C,there were 17 cases of Type? CSP and 14 cases of type ? CSP.In group D,there were 16 cases of Type? CSP and 15 cases of type ? CSP.Collecte and analyse the general clinical data,operation time,blood loss,the length of hospital stay,hospitalization costs and the recovery time of blood ?-h CG of all patients by SPSS19.0 software.Results:1.Type? CSP four groups,type ? CSP two groups:there is no statistical difference in patients' age,times of pregnancy,numbers of cesarean delivery,times interval from the last cesarean delivery,days of pregnancy,the size of gestational sac,the levels of ?-h CG,thickness of the scar at the lower uterine segment?P>0.05?.2.Comparison between the four groups in Type? CSP?1?The success rates :the success rates of group A,B,C1 and D1 was respectively 61.5%,91.3%,100% and100%.Comparison between group A and other groups was statistical significance?P<0.05?,but there was no significant difference between group B,C1 and D1?P>0.05?.And it is said that the group A has the lowest success rate of the four groups.?2?Treatment effect:the average blood loss of group A,B,C1 and D1 was respectively?124.62±85.04?ml,?84.87±47.55?ml,?41.76±7.89?ml,?17.81±5.15?ml,comparison between four groups of data was statistical significance?P<0.05?.And the average blood loss of group A>B>C1>D1,because all differences of them were statistically significant?P<0.05?.The mean operation time of the four groups were?57.69±14.09?min,?43.26±12.52?min,?24.71±6.24?min and?23.43±9.08?min respectively,and the comparison between four groups of data was statistical significance?P<0.05?.And the group A has the longest operation time of the four groups,the group B followed it,the differences of them were statistically significant?P<0.05?,which was not statistically significant?P>0.05?in group C1 and group D1.The mean recovery time of blood?-h CG of the four groups were?31.23 ± 5.90?days,?29.39 ± 5.03?days,?28.82 ± 6.55?days,?29.75 ±6.97?days,and there was no significant difference between the four groups?P> 0.05?.?3?Hospital stay and hospitalization costs:the mean length of hospital stay of group A,B,C1 and D1 was respectively?4.77±1.88?days,?10.43 ± 1.97?days,?7.76 ± 1.35?days and?7.81 ± 1.38?days,comparison between four groups of data was statistical significance?P< 0.05?.And group B has the longest hospitalization days of the four groups,group A has the shortest hospitalization days of the four groups,the differences of them were statistically significant?P<0.05?.But there not statistically significant?P>0.05?in group C1 and group D1.The average hospitalization costs of four groups were?13805.69±3593.67?RMB,?8284.43 ± 840.37?RMB,?8067.41 ± 437.01?RMB and?21595.53±1594.36?RMB respectively,and the difference between four gruops was statistically significant?P <0.05?.And the group D1 has the highest hospitalization costs of the four groups,the group A followed it,the differences of them were statistically significant?P<0.05?,which was not statistically significant?P>0.05?in group B and group C1.3.Comparison between the two groups in Type ? CSP?1?The success rates:the success rates of group C2 and D2 was respectively50.0%,86.7%.And the difference was statistically significant?P<0.05?.It is said that the success rate of group D2 was higher than group C2.?2?Treatment effect:the average blood loss of group C2 and D2 was respectively?87.14±48.23?ml,?36.67±46.01?ml.And the difference was statistically significant?P<0.05?.It is said that the average blood loss of group C2 was more than group D2.The mean operation time of the two groups were?44.64±15.99?min,?22.27±11.02?min respectively,and the difference was statistically significant?P<0.05?.It is said that the mean operation time of group C2 was greater than group D2.The mean recovery time of blood?-h CG of the the two groups were?36.64 ± 13.62?days,?33.47 ± 13.49?days,and there was no significant difference between the two groups?P>0.05?.?3?Hospital stay and hospitalization costs:the mean length of hospital stay of group C2 and D2 was respectively?12.07±2.87?days,?8.07±2.15?days,comparison between two groups of data was statistical significance?P<0.05?.It is said that the mean length of hospital stay of group C2 was longer than group D2.The average hospitalization costs of two groups was?11859.5± 3230.4?RMB,?22312.2±2276.8?RMB,and the comparison between two groups of data was statistical significance?P<0.05?.It is said that the average hospitalization costs of group D2 was more than group C2.4.Comparison between the Type? CSP and Type ? CSP:the success rates of Type? CSP and type ? CSP was respectively89.9% and 69.0%.And the difference was statistically significant?P<0.05?,it is said that the success rate of Type? CSP was higher than type ? CSP.Conclusion:1.The overall effectiveness of hysteroscopy in the treatment of type CSP I was higher than that of type CSP ?.2.After given pretreatment can obtain a higher success rate,targeted drug injection and UAE pretreatment can significantly reduce the amount of bleeding,shorten operation time and hospitalization time,while hysteroscopy in treatment of patients with Type? CSP.For patients of poor economic conditions,we can prefer to targeted drug injection pretreatment,and for patients of good economic conditions and the pursuit of treatment effectiveness,we can can choose UAE pretreatment.3.UAE pretreatment treatment success rate was significantly higher than that of targeted drug injection,and less bleeding,shorter operation time and hospitalization time,as the first choice of pretreatment when hysteroscopic treatment of type ? CSP. |
PDF Full Text Request