| Objective To compare the clinical effect of bilateral uterus artery mbolization plus curettage,laparoscopic cesarean scar Pregnancy debridement surgery plus myometrium neoplasty,and laparoscopic bilateral uterine artery ligation plus curettage in patients with cesarean scar pregnancy.Methods Clinical data of patients with cesarean scar pregnancy who visited our hospital and received the treatment of bilateral uterus artery mbolization plus curettage,laparoscopic cesarean scar pregnancy debridement surgery plus myometrium neoplasty,and laparoscopic bilateral uterine artery ligation plus curettage in January 2014-Decmber 2016 were restrspective analyezed.A total of 131 patients were incuded according to the inclusion and rejection criterion and were divided into Group A,Group B and Group C.There were 61 cases in Group A who received treatment of bilateral uterus artery mbolization plus curettage;there were 50 cases in Group B who received treatment of laparoscopic cesarean scar Pregnancy debridement surgery plus myometrium neoplasty;there were 20 cases in Group C who received treatment of laparoscopic bilateral uterine artery ligation plus curettage.The years old,times of historical fertilization,times of historical delivery,method of historical cesarean delivery,interval from historical delivery to last fertilization,time of last pregnancy,the level of ?-human chorionic gonadotropin(?-h CG)in menstrual blood,focus size under laparoscopy,blood loss during operation,duriation of operation,successful rate of operation,duration of bleeding in vagina,recovery time for ?-h CG in menstrual blood to nomal level,hospital stays,total expense in hospital and postoperative complications in three groups were analyzed in statistic.Results(1)The years old,times of historical fertilization,times of historical delivery,method of historical cesarean delivery,interval from historical delivery to last fertilization,time of last pregnancy,the level of ?-human chorionic gonadotropin(?-h CG)in menstrual blood,focus size under laparoscopy in three groups were not significantly different in statistic(P>0.05).(2)Duriation of operation in Group B and Group C were significantly prolonged and blood loss during operation in Group B and Group C were significantly increased,duriation of operation compare with those in Group A(P<0.05).Duriation of operation and blood loss during operation in Group B and Group C were not significantly different(P>0.05).(3)Successful rate of operation in three groups were not significantly different(P>0.05).Duration of bleeding in vagina,recovery time for ?-h CG in menstrual blood to nomal level and recovery time for menstruation in Group B and Group C were significantly shortened compare with those in Group A(P<0.05).Duration of bleeding in vagina,recovery time for ?-h CG in menstrual blood to nomal level and recovery time for menstruation in Group B and Group C were not significantly different(P>0.05).(4)Hospital stays in Group B and Group C were significantly shortened,total expense in hospital in Group B and Group C were significantly increased compare with those in Group A(P<0.05).Hospital stays and total expense in hospital in Group B and Group C were not significantly different(P>0.05).(5)The main postoperative complications included postoperative fever,postoperative pain and damage of near organs.The incidence of single and total complication in three groups were not significantly different(P>0.05).Conclusion(1)Treatment of bilateral uterus artery mbolization plus curettage with retention characteristics of reproductive function,less trauma,less bleeding,less adverse reactions.In the case of bleeding,the patient is in critical condition,bilateral uterus artery mbolization can be used to quickly control bleeding and stable condition.But the basis for equipment and operation of DSA hospital doctor higher technical requirements,and in the promotion of grass-roots hospital by some obstacles.(2)Treatment of laparoscopic cesarean scar pregnancy debridement surgery plus myometrium neoplasty is worthy promotion with advantage of complete removal of focus,rapid recovery,short hospital stay,reservation of fertility function,and can repair scar defects,can reduce the risk of long-term recurrence of CSP,therefore,is especially suitable for the stable condition and the scar thickness <3mm,II type CSP,fertility requirements of patients,but the doctors need surgery technology good to complete,and prepare for do laparotomy.(3)Treatment of laparoscopic bilateral uterine artery ligation plus curettage with rapid recovery,short hospital stay,reservation of fertility function,especially in the laparoscopic uterine artery occlusion,the result is reliable.In the course of treatment of laparoscopic cesarean scar pregnancy debridement surgery plus myometrium neoplasty,such as large package,the amount of bleeding is inevitable,can be combined with such a surgical program to reduce intraoperative bleeding.But its operation is complex,operation time is extended accordingly,so the surgeon laparoscopic technology requirements are very high,it is difficult to promote in primary hospitals. |
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