| Objective:Through the retrospective analysis 96 cases,in March 2015-December 2018,using systemic drug killing embryos or Uterine artery chemoembolization pregnancy under two kinds of pretreatment method,and hysteroscopic removal of pregnancy lesions or laparotomy for removal of pregnancy lesions plus Uterine scar repair two kinds of surgical treatment of Cesarean scar pregnancy in patients with clinical data,To explore the therapeutic effects and indications of two pretreatment methods and two surgical methods,and to provide the basis for clinical work.Methods:There were 96 patients with CSP,32 with type I,40 with type II,and 24 with type III.They were divided into four groups according to the preoperative pretreatment and surgical methods.Group A:total of 20 cases were treated with systemic drug embryo killing plus hysteroscopic removal of pregnancy lesions.Group B:UACE+ hysteroscopic removal of pregnancy lesions,a total of 42 cases.Group C:a total of 20 cases were treated with systemic drug embryo killing,transabdominal gestation lesion removal and uterine scar repair.Group D:UACE+ debridement of scar pregnancy + scar repair of uterus,a total of 14 cases.Basic clinical data,intraoperative situation data and treatment outcome data of all patients were collected for statistical analysis with SPSS.Results:The basic clinical data of type I CSP patients showed no statistically significant difference between the groups(P>0.05),which was comparable.Treatment was successful in groups A and B(100%).There were no significant differences in intraoperative blood loss,operation time,blood HCG conversion to negative,menstrual recovery,and length of stay between the two groups(P>0.05).The hospitalization cost of group B was significantly higher than that of group A(P<0.05).The basic clinical data of patients with type Ⅱ CSP were not statistically significant(P>0.05),which was comparable.The success rates of the four groups were:group A(57.1%),group B(94.4%),group C(100%),and group D(100%).The intraoperative blood loss and operation time of the transabdominal surgery group(group C,group D)were significantly greater than those of the hysteroscopic surgery group(group A,group B),and the difference was statistically significant(P<0.05).Compared with group A and group B who underwent hysteroscopic surgery at the same time,the intraoperative blood loss and operation time of group A were significantly greater than that of group B,and the hospitalization cost was significantly lower than that of group B,with statistically significant differences(P<0.05).Meanwhile,the intraoperative blood loss in group C was significantly higher than that in group D,and the hospitalization cost was significantly lower than that in group D(P<0.05).The amount of intraoperative blood loss and operation time in the UACE group(group B,group D)were significantly lower than those in the UACE group(group A,group C),and the menstrual recovery and hospitalization cost were significantly higher than those in the UACE group(P<0.05).Basic clinical data of patients with typeⅢCSP showed no statistically significant difference between the groups(P>0.05),which was comparable.The success rates of the four groups were:group A(50%),group B(66.7%),group C(100%)and group D(100%).The operative time of transabdominal surgery group(group C,group D)was significantly longer than that of hysteroscopic surgery group(group A,group B),and the difference was statistically significant(P<0.05).Meanwhile,the intraoperative blood loss in group C was significantly higher than that in group D,and the hospitalization cost was significantly lower than that in group D(P<0.05).Conclusion:1.Hysteroscopic surgery is safe and effective for patients with type I CSP;Uterine artery embolization had no effect on the success rate.2.For patients with type Ⅱ CSP,uterine artery embolization can significantly reduce intraoperative bleeding,reduce operation time,and increase the success rate of patients with CSP.3.When removing pregnancy lesions through abdominal surgery,scar can be repaired and the incidence of re-scar pregnancy can be reduced.It has a good therapeutic effect for patients with acute and severe diseases and those who need re-pregnancy. |
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