| Purpose: To explore the clinical features and different operations,therapeutic effects during early pregnancy loss to patients with cesarean scar ectopic pregnancy(CSP).Methods: Retrospective analysis of the clinical data of 74 cases of CSP patients treated in the Dalian Obstetrics and Gynecology Hospital from April 2014 to December 2017.According to the Americain society of radiologists in Ultrasound guidelines,the clinical data of 74 cases in the early stage of pregnancy loss with scar ectopic pregnancy was diagnosed by transvaginal ultrasonography.According to the types of operations and therapeutics,the patients were divided into 4 groups A,B,C,D.A group(hysteroscopic,19 patients),B group(uterine curettage,45 patients),C group(MTX combined with oral mifepristone followed by Hysteroscopy,4 patients),and D group(MTX combined with oral mifepristone followed by curettage,6 patients),and the patients in each group were divided into type I and type II.The operation time,the amounts of blood loss during operation,the hospitalization time after surgery,analyzed for the serum ?-human chorionic gonadotrophin(HCG)level before and after the operation and after the therapy,the time of ?-h CG return to normal were detected,in the four groups were compared.Results: All cases were successfully cured,In A group there was no statistically significant difference between type I and type II(P>0.05),same for the group B,C and D There was no statistically significant difference between the type I and type II(p>005).Among the patients of type I,the amount of blood loss during operation in group C was significantly longer than the other 3 groups with statistically significant difference(F = 4.19 P = 0.00);hospitalization time between 4 groups no statistically significant difference(P>0 05).The operation time in group B waslonger than that the other 3 Groups(F = 1.18 P = 0.11).Among the patients of type II,the amount of blood loss during operation in group C was significantly longer than the other 3 groups with statistically significant difference(F = 3.15 P = 0.00),hospitalization time group B was significantly higher than other 3 groups(F = 4.26 P = 0.00),the operation time between A,B,C group and D group had no statistically significant difference(p>0.05).There was statistically significant difference in the time of ?-h CG return to normal in group A(p<0.05),there was no statistically significant difference between ?-HCG return to normal in among the group B,C,D(p>0.05).The levels of serum ?-h CG after treatment were statistically significantly lower than those before treatment in the four groups(P<0.05).In each Group A and B after surgery 1 patient still had a small amount of continuous bleeding,and an 18 th Foley balloon urethral catheter was placed on the uterine cavity,compressed for hemostasis.They were removal after 24 hours,no significant bleeding;in Group A 1 case rented after discharge of hospital treatment;74 cases of pathology confirmed uterine scar pregnancy after cesarean section.Conclusion: Different treatment methods of endogenous and exogenous scar pregnancy surgery are significantly different,for the cesarean scar pregnancy patients,the choice of individualized treatment can improve the curative effect and prognosis of CSP patients,ultrasound diagnosis of lesions can improve to choose a reasonable way of operation is reassuring.Uterine curettage is the most suitable operative method in the early stage of cesarean scar pregnancy,but for some patients with severe invasion,hysteroscopy is to be exectude in order to provide full safety to the patient.Medical drugs and surgical treatment combined together may cause more bleeding of the patient during surgery. |
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