| Objective To analyze the clinical effects of different treatment options for cesarean scar pregnancy.Methods Collect the basic clinical data of 216 patients who were diagnosed as cesarean scar pregnancy by the Department of Maternal and Child Health Hospital of Anhui Province from August 2016 to August 2018.According to the different treatment methods,the patients are divided into 4 groups: 61 patients in group A(35,20,and 6 patients with type ?,?,and ?),and mifepristone or methotrexate combined with ultrasound-guided uterine surgery;36 Cases in group B(20,11,and 5 patients with type ?,?,and ?)were treated with methotrexate combined with bilateral uterine artery embolization.12 patients in group C(7,2,and 3 cases with types ?,?,and ?),uterine scar pregnancy and scar repair were performed after methotrexate combined with bilateral uterine artery embolization;107 patients in group D(54,25,28 cases with ?,?,and ?),the use of transvaginal uterine scar pregnancy and scar repair,scar repair.Observed and compared the perioperative indicators of 4 groups of patients [ blood ?-human chorionic gonadotropin(?-HCG)decline rate,intraoperative blood loss,length of hospital stay],hospitalization costs,postoperative complications,number of successful treatments andpostoperative follow-up indicators(blood ?-HCG drops to 5mIU/mL and below time,ultrasound showed the disappearance of the mass at the scar site,menstrual re-tidal time,the number of postoperative pregnancy cases and pregna ncy outcomes,etc.).Results 1.The patients had no significant difference in the number of cases,the history of pregnancy,the age of previous cesarean section,the number of ultra sound-visible embryos,the preoperative blood ?-HCG level,the maximum diameter of the gestational sac,and the clinical manifestations(P>0.05).2.In group C,the rate of blood ?-HCG decreased,the time when blood ?-HCG drops to 5mIU/mL and below,and the time when ultrasound showed scar disappeared in the scar group were better than the other three groups,but the hospitalization expenses and days were highest,the differences were statistically significant(P<0.05).There was significant difference in the amount of bleeding between the 4 groups(P<0.05).3.The number of successful treatments in the 4 groups was 54(54/61)in group A,36(36/36)in group B,12(12/12)in group C,and 106(106/107)in group D,and the difference was statistically significant(P<0.05).4.A total of151 patients were followed up after operation,including 39 patients in group A,26 patients in group B,10 patients in group C,and 76 patients in group D.There were 2(2/39)pregnancies in group A,1(1/10)in group C and 4(4/76)in group D.There was no significant difference between the 4 groups(P>0.05).The number of cases with a decrease in total menstrual flow after surgery,20(20/39)cases in group A,20(20/36)cases in group B,9(9/10)cases in group C,and 27(27/76)in group D for the 4 groups,the difference was statistically significant(P<0.05).The menstrual recovery time in group B was larger than that in the other 3 groups,and the difference was statistically significant(P<0.05).Conclusions Bilateral uterine artery embolization(UAE)can completely block the blood flow of uterine artery,reduce the risk of intraoperative and postoperative hemorrhage.After intervention,uterine scar pregnancy excision and scar repair are performed to completely remove the pregnant tissue and repair the scar tissue in pregnancy.It has high clinical cure rate,the safer and more effective,the fastest decline in peripheral blood ?-hCG,the shortest disappearance of the pregnancy mass at the scar,and preserve the integrity of the uterine organs.However,the hospitalization time is relatively long and the hospitalization cost is high.Therefore,for hospitals with medical conditions,Use this method as one of the main methods for treating cesarean scar pregnancy according to the patient's economic conditions. |
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