| BackgroundCesarean scar pregnancy(CSP)is a kind of ectopic pregnancy with a special implantation position in the gestational sac.It is dangerous and has a low incidence.Conservative treatment or treatment is not prone to uterine rupture,placental implantation,and major bleeding.When severely life-threatening,the uterus needs to be removed,and it is advisable to terminate the pregnancy as soon as possible after the diagnosis,to prevent the occurrence of serious complications,and to promote the recovery of fertility.In recent years,China's “second child” policy has been fully liberalized.Some women with a history of cesarean section expect to get pregnant again.The rate of cesarean section has been increasing year by year.Medical imaging technology has continued to improve and physicians 'awareness of the disease has increased.Incidence and diagnosis have increased significantly.At present,the relevant literature reports a variety of treatment options,the lack of big data to demonstrate the effectiveness of treatment is controversial,and there is currently no recognized best treatment option.ObjectiveCompare laparoscopic temporary iliac artery interruption + scar pregnancy lesion removal + uterine scar repair + hysteroscopy,uterine artery embolization(UAE)+ ultrasound-guided evacuation,Resection of vaginal scar pregnancy lesion resection + uterine scar repair,Three methods of focus resection and uterine scar repair for the treatment of type ? CSP: surgical success rate,operation time,intraoperative blood loss,hospital stay,hospitalization cost,and postoperative follow-up indicators The clinical efficacy,practicality and safety of CSP treatment.MethodsAccording to the inclusion and exclusion criteria,a total of 125 patients with type ? CSP who were treated at The First Affiliated Hospital of Henan University from January 01,2017 to December 31,2019 were collected for retrospective analysis.The patients were divided into three groups according to different treatment methods.A total of 36 patients in group A underwent laparoscopic temporary iliac artery interruption + scar pregnancy lesion removal + uterine scar repair + hysteroscopy.A total of 53 patients in group B underwent UAE + ultrasound-guided uterine evacuation.A total of 36 patients in group C received vaginal scar pregnancy lesion resection + uterine scar repair.Preoperative general clinical data extracted from electronic medical records include patient age,number of days of menopause,abdominal pain,number of pregnancy,number of births,number of previous cesarean sections,number of abortions,time from previous cesarean section,history of pelvic and abdominal surgery,surgery anterior blood ?-h CG value,lesion diameter,primitive cardiac pulsation,residual myometrium thickness(RMT),surgical status and hospitalization information including operation time,intraoperative blood loss,hospitalization cost,hospitalization time,postoperative the follow-up indicators include the success rate of surgery,menstrual rejuvenation,and the time of blood ?-h CG negative conversion.Postoperative follow-up information can be obtained by phone,text message,or We Chat to ensure the authenticity and accuracy of the information collected.The clinical data of the three treatment methods were analyzed statistically,and the clinical efficacy,practicability and safety of the three treatment methods were compared.Results(1)There was no statistically significant difference in preoperative general clinical data of patients in groups A,B and C(P>0.05).The surgical status and hospitalization information,postoperative follow-up of the three treatment options were comparable.(2)In the comparison of the operation time of the three groups,the operation time of group A was the longest,followed by that of group C,and the shortest of group B.There was a statistically significant difference(P<0.05).The intraoperative blood loss and hospitalization costs of group A were not significantly different from those of group B,and were not statistically significant(P>0.05).The intraoperative blood loss and hospitalization costs of group C were the most significant,which were significantly different from those of groups A and B,Statistical significance(P<0.05).There was no significant difference in hospitalization time between group A and group C(P>0.05).The hospitalization time of group B was significantly longer than that of group A and group C,and the difference was statistically significant(P<0.05).(3)The operation success rates of group A,group B,and group C were 100%,94.3%,and 97.2%,respectively.There was no significant difference between the three groups(P>0.05).Among the three groups,group A had the shortest period of menstrual resurgence and serum ?-h CG turning negative,followed by group C,and group B the longest.The difference between the two groups was statistically significant(P<0.05).Conclusion(1)Each of the three methods has advantages in the treatment of type?CSP,and the success rate of treatment is high.It is necessary to comprehensively consider the patient's individual situation,economic factors,hospital's basic equipment,and the doctor's technical level to develop a suitable individualized treatment plan.(2)Laparoscopic temporary iliac artery interruption + scar pregnancy lesion removal + uterine scar repair + hysteroscopy for the treatment of type ?CSP can significantly reduce the risk of intraoperative bleeding,hospitalization days,postoperative serum ?-h CG levels The decline and rapid menstrual resurgence require high doctors' surgical techniques and medical equipment,and the operation time and treatment costs have increased significantly.(3)UAE + ultrasound-guided uterine evacuation for the treatment of type ?CSP can quickly control bleeding,the amount of bleeding during uterine surgery is less,but the length of hospital stay and postoperative recovery time is significantly prolonged and the cost of hospitalization is expensive.(4)vaginal scar pregnancy lesion resection + uterine scar repair for the treatment of type?CSP has the advantages of shorter hospitalization time,operation time and recovery time,and lower hospitalization costs,but there are more intraoperative blood loss and further improvement of the quality of surgery. |
PDF Full Text Request