| Objective:To investigate the clinical features,diagnosis and treatment effect of different types of cesarean scar pregnancy(CSP),and provide reasonable basis for the diagnosis and treatment of CSP in clinic.Methods:Retrospectively analyze the clinical information of 118 cases of cesarean scar pregnancy patients which were treated in the Laoshan Hospital Affiliated of Qingdao University from July 2013 to September 2016.All patients were diagnosed by transvaginal color doppler sonography,which contained 42 type I cesarean scar pregnancy cases(CSP-I,endogenous type)and 76 type II cesarean scar pregnancy cases(CSP-II,exogenous type).Among the 42 CSP-I cases,twenty-nine patients received drug therapy combined with ultrasound-guided curettage(group A),and the other 13 patients only received ultrasound-guided curettage(group B).Among the 76 CSP-II cases,forty-five cases underwent transvaginal debridement and uterine repair(group C),twenty-five cases were treated by laparotomy debridement and uterine repair(group D)and 6 cases received uterine artery embolization combined with laparotomy(group E).Through comprehensively evaluate A and B group,C and D group by indexes of the operation time,the intraoperative blood loss,the postoperative recovery time of serum human chorionic gonadotropin-b,the hospitalization time and expenses,the success rate of treatment and other indicaters,we provide reasonable basis for the clinical diagnosis and treatment of different types of CSP patients.All data were analyzed by SPSS 17 software.Results:1.Only 1 patient in B group was changed to UAE combined with laparotomy due to uterine hemorrhage during ultrasound-guided curettage,the other patients in B group and all A group patients were underwent successfully surgery.There were no statistically significance of the differences in patients' age,gestational age,number of cesarean delivery,the time from the last cesarean delivery,gestational sac size,the preoperative lever of serum ?-HCG,the thickness of the myometrium in cesarean scar between A and B group(P>0.05).The operation time and intraoperation blood loss of A group were less than that of B group,and the hospitalization time and expenses were more than that of B group,the differences had statistical significance(P<0.05),and the difference of the postoperative recovery time of serum b-HCG between A and B group had no statistically significance(P<0.05).2.Only 1 patient in C group was changed to laparotomy due to operation difficulty during transvaginal surgery,the other patients in C group and D group were underwent successfully surgery.The difference in patients' age,number of cesarean delivery,the time from the last cesarean delivery,gestational sac size,the preoperative level of serum?-HCG and the thickness of the myometrium in cesarean scar between C and D group had no statistically significance(P>0.05).The intraoperative blood loss,operation time,the hospitalization time and expenses of C group were obviously less than that of D group,the differences had statistically significance(P < 0.05),and there was no statistically significance in the difference between the postoperative recovery time of serum b-HCG of C and D group(P<0.05).UAE combined with laparotomy can be used for rescue treatment of CSP patients with uterine hemorrhage,or the preventive treatment of CSP patients who with the degree of blood flow in the lesion was III grade and it can also be used as a kind of remedial treatment when other treatments failed.3.All the operations were performed successfully,and their fertility functions were preserved.Conclusion:1.The main clinical symptom of CSP is painless vaginal bleeding after menopause,which has no specificity.So the misdiagnosis rate is extremely high.2.Ultrasonography is the main diagnostic method for CSP,especially transvaginal color doppler ultrasound which can clearly classify the type of CSP.This has great significance in guiding clinical treatment.3.Drugs combined with ultrasound-guided curettage and the simple ultrasoundguided curettage can be used to treat the patients with type CSP-I.4.The operation of cesarean scar pregnancy debridement and uterine repair which contains transvaginal surgery,laparotomy and UAE combined with laparotomy can be used to treat type CSP-II.The transvaginal surgery is superior to laparotomy,because of its advantages in shorter operation time,less intraoperative bleeding and faster postoperative recovery.So the transvaginal surgery is worthy of clinical promotion.UAE combined laparotomy can be used to rescue CSP patients with uterine hemorrhage,treat patients with with the degree of blood flow in the lesion was III grade,and it can also be used as a kind of remedial treatment after other treatments fail. |
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