| Objective:The clinical data of type ? cesarean scar pregnancy(CSP)patients were retrospectively analyzed.Three different treatment methods were compared to evaluate their effectiveness and safety,and to provide a certain clinical basis for how to choose the best treatment.Method: 135 patients with type ? CSP admitted to Tianjin Hospital from January 2014 to June 2017 were selected as the study subjects.They were treated by longitudinal or transverse incision of lower uterine segment and showed high-speed and low-resistance blood flow signals with abundant trophoblast in scar by color Doppler.According to different treatment methods,135 patients were divided into three groups: group A: mifepristone + superconductive hysterectomy,a total of 45 cases;group B: uterine artery chemoembolization(UACE)+ hysterectomy,a total of 60 cases;group C: Transvaginal debridement and repair surgery(TDRS),a total of 30 cases.The clinical data of 135 patients were analyzed retrospectively.The menopausal days,preoperative human chorionic gonadotropin(HCG)level,operation time,intraoperative bleeding volume,post-operative recovery of HCG to normal time,success rate of first treatment,hospitalization time,hospitalization costs and other factors were analyzed and compared.The time of menstrual resurgence,the change of menstrual volume and the condition of second pregnancy were followed up,and the effect of UACE on ovarian function was evaluated.Result:(1)The success rate of the first treatment was 75.55% in group A,88.33% in group B and 96.67% in group C.The difference between group C and group A and B was statistically significant(p < 0.05).(2)Intraoperative bleeding volume: 80.54(+20.56 ml)in group A,25.78(+5.79 ml)in group B,69.54(+20.6 ml)in group C,the least in group B,the most in group A,the difference was statistically significant(p < 0.05).(3)Operation time: Group B had the shortest operation time and Group C had the longest operation time,with significant difference(P < 0.05).(4)The decrease of beta-HCG after operation was the shortest in group C(21.0 +7.9 d)and in group B(29.2 +8.9 d)compared with group A(38.1 +6.9 d),with significant difference(p < 0.05).(5)Hospitalization time: group C(4.0 +2.2 d)was significantly shorter than group A(9.04 +0.53 d)and group B(10.5 +3.5 d),with statistical significance(p < 0.05).(6)Hospitalization expenses: group B was the highest,group A was lower than group C,the difference was statistically significant(p < 0.05).(7)Postoperative follow-up: There was no significant difference in menstrual recovery time,menstrual volume change,intrauterine pregnancy rate and incidence of CSP among the three groups(P > 0.05).Conclusion:(1)Type ? CSP is still a serious threat to women's health.If improper treatment can lead to serious complications,we must pay attention to it.(2)Individualized treatment was assessed according to the hospital's medical ability and patient's personal factors,economic situation,condition and whether it could cooperate with long-term follow-up.Different treatments have their own advantages and disadvantages.(3)Mifepristone + superconducting uterine curettage is a simple and easy operation,with less injury,low hospitalization costs,a short time to re-pregnancy,high failure rate,more bleeding during operation,slow decreaseof HCG after operation,and long hospitalization time.(4)uterine artery chemoembolization(UACE)+ hysterectomy can significantly reduce the risk of bleeding during and after operation,preserve uterine integrity,have a high success rate,high hospitalization costs,and require high surgical technology and medical equipment.(5)Transvaginal debridement and repair surgery has a high success rate.After operation,the level of HCG declines rapidly,the recovery time is short,the cost is low,and the complications are few.It can repair the normal anatomical structure of patients,and it is worth promoting.(6)The three treatments had no effect on the second pregnancy and did not increase the recurrence rate of CSP. |
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