Analysis Of The Curative Efficacy Of Three Kinds Of Treatment Methods In The ? And ? Types Of Cesarean Scars Pregnancy(CSP)

Objective:To explore the clinical efficacy of hysteroscopic embryo removal,transvaginal embryo focus removal repair,laparoscopic embryo focus removal repair for I and II types cesarean scars pregnancy.To provide methods and basis for the selection of treatment methods in the process of clinical treatment.Methods:To select 105 cases of I and II types of cesarean scars pregnancy from January 2016 to January 2018 in the first affiliated Hospital of Nanchang University.The clinical data were analyzed retrospectively.Divide the patients into three groups(38?32?35)?Group A uses hysteroscopic embryo removal.Group B uses vaginal embryo removal and repair.Group C uses laparoscopic embryo removal and repair.Analyse and compare the general situation of the three groups of patients,including age,menopause days,previous cesarean times,gestational sac size,etc.To trace and to count the amount of intraoperative bleeding,the operation time,the days of postoperative vaginal bleeding,the longth of stay,the longth of blood ?-HCG returning to normal for the evaluation of the curative efficacy of three kinds of operation methods on cesarean scars pregnancy.Results:1.There was no significant difference between the three groups in age(31.49 ±4.96?31.39 ±5.73?31.55 ±4.02)and the previous cesarean times(1.51 ±0.65?1.58±0.75?1.35 ±0.69)(p > 0.05).Significant difference exists between group A and group B?C on the menopausal days(49.13 ±10.41,58.05 ±13.29,58.0±13.47)and gestational sac size(2.60 ±0.25,3.60 ±0.23,3.57 ±0.20)respectively.There was no significant difference between group B and C(P > 0.05).2.The days of postoperative vaginal bleeding(3.14±0.62?3.05±0.68)and ?-HCG recovery(28.23±4.20?27.26±4.53)of group B?C are shorter than group A(5.76±1.02?40.0±9.12).There was no significant difference between group B and C(P > 0.05).The operative time(30.01±3.11?35.12±3.09),the volume of blood loss during operation(80.94±5.85?78.00±5.09),the postoperative hospitalization time(3.05±0.97?3.10±0.89)in group B and C are longer than group A(15.02±3.82?43.0±5.09?1.02±0.14).There was no significant difference between group B and C.(P > 0.05).3.One of 38 patients in group A was treated with laparoscope because of the difficulty of controlling intraoperative bleeding by hysteroscope.In group B,2 cases were treated by laparoscopy.In group C 1 cases was treated with transabdominal hemostasis because of hemorrhage,4 cases were treated by temporary occlusion of bilateral uterine artery during operation.The success rate in group A was 97.37% and that in group B was 93.75% and 97.14% in group C.4.10 cases in group A were treated with balloon compression hemostasis because of postoperative vaginal bleeding.5cases in group B and 3cases in group C.All patients' balloons were removed after 24 hours,the vaginal bleeding is little,all the patients are in good condition.Conclusion:1.Hysteroscope,Vaginal surgery,and laparoscope are effective and available in type I and II types of cesarean scars pregnancy.2.For the patients with short menopause time(< 7 weeks)and small gestational sac(< 2.6 cm),hysteroscope should be considered,at the same time we should prepare blood conducts and other surgical supplementary treatments.3.For the type I and II types of CSP with larger pregnancy sac and longer menopause time,Vaginal surgery or laparoscopic treatment can be selected.The clinical choice should be considered synthetically,such as: it is not suitable for the patients of I and II types of CSP who have poor uterine activity treating with Vaginal surgery.Preoperative evaluation of intraoperative bleeding may occur a large amount of bleeding(according to the location of pregnancy sac,uterine activity,blood supply,etc.)can choose laparoscopic surgery,which is conducive to the temporary occlusion of uterine artery to reduce intraoperative bleeding.