| Objective:The aim of the study was to analysis the general clinical data,treatment and follow-up of 124 cases of cesarean scar pregnancy,to discuss the risk factors for CSP and the selection and evaluation of the therapeutic methods for different types of caesarean scar pregnancy.Methods:A retrospective analysis was conducted on the clinical data of 124 patients with CSP in the department of Gynecology,First Affiliated Hospital of Chongqing Medical University,form September 2015 to November 2017.Discussing the risk factors for CSP and compare the curative effect of different types of CSP with hysteroscopic and laparoscopic surgery from various aspects,such as the general clinical data,treatment and follow-up.Analysising and processing the data with SPSS 23.0 version statistical software,the measurement data of mean(X±S)said,using Mann-Whitney U test analysis data,P<0.05,the difference was statistically significant.Results:1.General situation:124 cases of cesarean scar pregnancy age 22-43(33±4.7)years old.81 patients had section 1 time,40 patients had section 2 times,3 patients had greater than or equal to cesarean section 3 times.Abortion times 0-8(2.4±1.7)times.The last cesarean section of all patients was transverse incision of the lower segment of the uterus.The time interval from the last cesarean section was about 11 months-17 years(71.9±38.6 months).All patients had a clear history of amenorrhea,and the time was 36-106(52.2±13.6)days.The value of ?-HCG was 52.44-225548(65525.1±65057)mIU/ml at the first visit.2.Clinical features:14 patients had vaginal bleeding after medical abortion and curettage in other hospitals.45 patients had no obvious symptoms,and they detected positive HCG in urine,and were confirmed by ultrasonography.62 patients had irregular vaginal bleeding after amenorrhea(55 cases of a small amount of bleeding,7 cases of bleeding greater than the amount of menstruation),20 patients with different degrees of lower abdominal pain.3 patients only had abdominal distention and pain in the lower abdomen.3.Operation and follow-up:Hysteroscopy 102 cases,I type 69 cases,type ? 33 cases,menstrual recovery time 31.72±5.72 days,serum beta-HCG decreased to normal time 52.05±19.72 days.Hysteroscopy combined with laparoscopy 9 cases,type I 1 case,type ? 4 cases,type ? 4 cases,menstrual recovery time 32.11±5.68 days,4 patients examined serum?-HCG regularly,50.25±11.59 days to normal.Laparoscopy or laparotomy 13 cases,type ? 3 cases,type ? 10 cases,menstrual recovery time 25±7.07 days,5 patients examined serum ?-HCG regularly,45.25±26.12 days to normal.All the operations were successful.There were no obvious complications during and after the operation.Conclusion:1.The clinical manifestations of CSP are not specific and easy to be misdiagnosed and missed.For patients with the history of cesarean section,cesarean scar pregnancy may be excluded as soon as possible.2.Ultrasonography is the preferred diagnostic method for CSP.For patients with a history of cesarean section,early gynecologic ultrasonography can early diagnose,early intervention and improve prognosis.3.The number of abortions may be the high risk factors for CSP.4.CSP treatment principles:early diagnosis,timely termination,complete clearance of pregnancy sac,reduction of complications and retain the fertility of the patient as much as possible.Formulating the best individualized treatment after comprehensive analysis,comprehensive evaluation and sufficient doctor-patient communication according to the specific conditions of patients.5.Severe CSP can endanger the life of patients.Therefore,correct and effective contraception measures should be taken after cesarean section. |
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