| Objective:Scar pregnancy after Cesarean section?Cesarean scar pregnancy,CSP?refers to the pregnant bursa,villi and placenta implantation in previous Cesarean section uterine incision scar place,fully or partially located in outside the cavity of the uterus,surrounded by myometrium or fiber connective tissue around,is a special kind of ectopic pregnancy[1].With the opening up of the into China two-child policy over the years,the increase of cesarean section rate,CSP is no longer a rare disease.Comprehensive research at present,its etiology is not entirely clear,most scholars believe that happen with previous cesarean section part of the CSP endometrial stromal decidual lack of dislocation,suture of incision and infection,poor healing,endometritis,etc.Its history and clinical manifestations of the lack of specificity,mainly has a history of cesarean section surgery,with a history of menopause,with or without vaginal bleeding and abdominal pain,serious when,uterine rupture and hemorrhage shock may occur,and even life threatening.With the increase of incidence of CSP,at present there are many methods for the treatment of CSP,mainly includes:1.The medicine conservative treatment,for example,methotrexate?MTX?,mifepristone,radix trichosanthis,potassium chloride and so on,can systemic use,can also be used in combination with local drug delivery.2.The uterine artery embolization?UAE?.3.Surgical treatment,such as to,suction and curettage,removal of gestational sac under hysteroscopy,laparoscope,direct the whole uterus total or partial hysterectomy etc.,But the current mode of laparoscopic partial resection of the lesions than other research progress and the level is still relatively lack,therefore,we design and research the laparoscopic partial resection of the lesions compared with traditional open operation indications,characteristics and advantages and disadvantages,and for many clinicians provides some recommendations for the treatment of CSP.Methods:Retrospective analysis between September 2012 and March 2012 visits the third hospital affiliated to guangzhou medical university and hospitalization of patients,the patients with ultrasound diagnosis of uterine cesarean section scar pregnancy?CSP?,a total of 295.Among them,the screen during the stay in hospital accepted laparoscopic,abdominal or vaginal surgery for uterine scar pregnancy lesion resection and uterine uterus repair,meet the personal data and clinical information comprehensively and the menstrual cycle,menopause time is 6 to 8 weeks,a total of105 cases,the patients with postoperative pathologic results suggest early villi and decidua tissue.The 105 patients into three groups,among them,41 patients with laparoscopic uterine scar pregnancy lesion resection+uterine repairing?group A?,and 44 patients with abdominal lesion resection of uterine scar pregnancy+uterine repairing?group B?,20 patients with vaginal uterine scar pregnancy lesion resection+uterine repairing?group C??Group A is divided into three groups,respectively is:A1group:preoperative MTX pretreatment+laparoscopic uterine scar pregnancy lesion resection+uterus repair surgery group?10cases?;A2 group:laparoscopic uterine scar pregnancy lesion resection+uterus repair+suction and curettage surgery,group?20cases?;A3 group:pure laparoscopic uterine scar pregnancy lesion resection and uterus repair surgery treatment group?11 cases?.More about the basic information of the above,the type of CSP and blood beta hCG levels of downward trend,postoperative blood beta hCG dropped to normal?beta hCG<5 iu/L?time,the difference of hemoglobin before and after operation,intraoperative blood loss,operative time,length of hospital stay,the total cost of a hospital clinical data were retrospectively analyzed.All data with SPSS21.0 version of statistical software,measuring data of normal distribution of the mean to meanąstandard deviation,said the mean differences between the two groups to compare the F test after using t test,multiple comparison using one-way ANOVA analysis of variance,mean the non-normal distribution median?interquartile spacing?,said the mean comparison using nonparametric test?the Mann-Whitney or Kruskal Wallis test?;Count data comparison with chi-square test,P<0.05 for the difference was statistically significant.Results:1.The comparison between group A,group B and group CThe comparison of three groups of patients before treatment basic information:three groups of onset age,menopause time,pregnant time,production time,distance,cesarean delivery times,preoperative cesarean delivery time last beta hCG,preoperative hemoglobin,the diameter of the gestational sac comparison,there were no statistically significant difference?P>0.05?.The curative effect of three groups:group B of beta hCG turn time,intraoperative blood loss,compared with other two small group,the difference was statistically significant?P<0.05?.Group C of operation time,the length of the total cost of the other two groups of small,and the difference was statistically significant?P<0.05?.But between the three groups of beta hCG after drop,length of hospital stay,treatment success rate comparison,there were no statistically significant difference?P>0.05?.2.The comparison between A1,A2,A3 groupThe comparison of three groups of patients before treatment basic information:age,menopause time,pregnant time,distance,preoperative cesarean delivery time last beta HCG,preoperative hemoglobin,ultrasound tip gestational sac diameter size is no statistical significance?P>0.05?,and production time,cesarean delivery times comparisons between groups,the difference was statistically significant?P<0.05?.Comparison of curative effect between three groups:group A1 of beta hCG after turn time,intraoperative blood loss,compared with the other two groups of small,and the difference was statistically significant?P<0.05?.But between the three groups of beta HCG drops range,operation time,postoperative hospitalization cost,length of hospital stay,treatment success,there was no statistically significant difference between groups?P>0.05?.Conclusion:1.For type II and type III CSP,should combine different illness and the patient's wishes,in guarantee under the premise of safe and effective,choose a different solution.2.Laparoscopic and abdominal and vaginal surgery of lesion resection+uterine scar pregnancy dressing technique contrast in the treatment of type II and type III in the CSP,vaginal surgery has the characteristics of the shortest operation time and hospitalization cost minimum;Turn the beta HCG traditional abdominal surgery time,less clear scar pregnancy were more thoroughly,and intraoperative under direct operation bleeding in a short time,emergency surgery is the first choice.Is as a kind of minimally invasive surgery,laparoscopic surgery for patients with less trauma,quick recovery,small side effects,and can retain the abdomen beautiful as far as possible.3.Laparoscopic surgery in the treatment of CSP at the same time,other ways can be combined,such as preoperative to MTX pretreatment,UAE pretreatment and laparoscopic surgical joint Suction and Curettage surgery,etc.To MTX pretreatment before surgery,can reduce intraoperative blood loss,speed up the advantages of the decline in beta HCG,worthy of clinical promotion. |
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