| Objective: For the time being,there is no uniform standard for diagnosing and treating cesarean scar pregnancy(CSP).Compare the advantages and disadvantages of hysteroscope in the diagnosis and treatment of type Ⅰ and Ⅱ CSP.Methods: The clinical classification of CSP was diagnosed according to the consensus of diagnosis and treatment of caesarean scar pregnancy after cesarean section,which was developed by the family planning group of the Chinese medical association.A retrospective analysis of clinical data from January 2015 to March 2018 in General Hospital Affiliated to Tianjin Medical University gynaecology and obstetrics with 121 cases of CSP,including type Ⅰ CSP 39 cases,19 type Ⅰ CSP underwent bilateral uterine artery embolization + curettage(UAE group),20 cases of type Ⅰ CSP underwent hysteroscopic scar lesion resection and curettage(hysteroscopic group).And type Ⅱ CSP 82 cases.23 cases of type Ⅱ CSP underwent bilateral uterine artery embolization + curettage(UAE group),21 cases of type Ⅰ CSP underwent hysteroscopic scar lesion resection and curettage(hysteroscopy group),38 cases of type Ⅱ CSP underwent laparoscopic bilateral uterine artery ligation and scar resection and repair of the uterus(laparoscopic group).Compare each group with intraoperative and postoperative situations.Results: All the 121 patients were operated successfully.Avoiding open surgery.No residual lesions were found in the ultrasound examination on the second day after surgery,and menstruation resumed within two months after surgery.No serious complications.Type I CSP: The operation time of the hysteroscopy group(45.8±32.4)min was shorter than embolization group(83.5±30.6)min.The length of hospitalization of hysteroscopy group(4.5±1.1)d was shorter than embolization group(6.9±1.0)d.The blood loss of hysteroscopy group(49.0±73.8)ml has no statistic difference with embolization group(59.3 ± 5.7)ml.The duration of anesthesia of hysteroscopy group(98.0±34.3)min more than embolization group(37.2±17.4)min.Type Ⅱ CSP: The operation time of hysteroscopy group(44.8 ± 19.7)min was shorter thanembolization group(79.0 ± 26.5)min and laparoscopic group(94.0±24.7)min.The intraoperative blood loss(28.3±19.5)ml was less than embolization group(63.7±12.4)ml and laparoscopic group(133.2 ± 187.1)ml.The anesthesia time of hysteroscopy group(91.2 ± 24.2)min was more than embolization group(37.8 ±22.2)min and shorter than laparoscopic group(155.1 ± 32.6min).The length of hospital stay of hysteroscopy group(4.6 ± 1.6)d was shorter than embolization group(5.8±1.4)d,but it has no statistic difference with laparoscopic group(5.1±1.7)d.Conclusion: 1.UAE combined with curettage,hysteroscopy and laparoscopic surgery are effective methods to treat CSP.2.Type I and type Ⅱ CSP were mainly manifested as vaginal bleeding,followed by abdominal pain or no symptoms,and a few were treated for early pregnancy.3.Hysteroscopy can directly show the attachment position,size and peripheral vascular distribution of the pregnancy sac.4.The advantages of hysteroscopic surgery: In the treatment of type Ⅰ CSP,the operation time and hospitalization time were shorter than that of the uterine arterial embolization.In the treatment of type Ⅱ CSP,surgical time and intraoperative blood loss were shorter than the other two treatments,total anesthesia time and hospitalization time were less than laparoscopic surgery.5.Hysteroscopic surgery is a minimally invasive,safe and effective treatment for CSP. |
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