| Objective:The clinical data of cesarean scar pregnancy(CSP)patients with cesarean section scar pregnancy were analyzed retrospectively,and the clinical effects of high intensity focused ultrasound(HIFU)ablation and uterine artery embolization(UAE)combined with ultrasound-guided uterine curettage in the treatment of CSP were compared,in order to provide a new idea and theoretical support for the treatment of CSP.Methods:From September 1,2017 to August 31,2019,the general data of CSP patients in Northwest women’s and children’s hospital were analyzed retrospectively.According to the different treatment methods,they were divided into two groups:59 cases in HIFU group were treated with HIFU combined with ultrasound-guided uterine curettage,91cases in UAE group were treated with UAE combined with ultrasound-guided uterine curettage.Through the analysis of the clinical data of the two groups(age,times of pregnancy,times of abortion,times of cesarean section,time from the last cesarean section,time of menopause,average diameter of pregnancy sac,whether fetal buds and fetal heart can be seen in the pregnancy sac,the value of human chorionic gonadotropin in blood before operation).The success rate of operation,the time of operation,the amount of blood loss during operation,the percentage of decrease of blood HCG on the 1st day after operation,the length of stay,the cost of hospitalization,the time when the blood HCG of patients returned to normal after operation,the menstruation after operation,the complications during and after operation and the situation of fertility were compared between the two groups.the therapeutic effects of the two groups were compared by combining the above indexes.The factors that may affect the blood loss during ultrasound-guided uterine curettage were analyzed by linear regression analysis,and the main factors affecting the blood loss were discussed.Results:1.Comparison of baseline data between the two groups:there was no statistical difference between the two groups in terms of age,number of pregnancy,number of abortion,number of cesarean section,time from the last cesarean section,preoperative condition:menopause time,average diameter of pregnancy sac,preoperative blood HCG value,CSP type and so on(P>0.05).2.Comparison of intraoperative blood loss,operative time,postoperative pain score,postoperative success rate and percentage of decrease of blood HCG 1 day after operation between the two groups:the time of uterine debridement in HIFU group was significantly shorter than that in UAE group(15.0 VS 25.0 P=0.001).The intraoperative blood loss in);HIFU group was significantly less than that in UAE group(20.0 VS 20.0 P=0.043);HIFU group was significantly lower than that in UAE group(1.85±0.738 VS 2.99±0.738P=0.001).There was no significant difference in the success rate of operation and the percentage of decrease of blood HCG 1 day after operation between the two groups(P>0.05).3.Comparison of hospitalization expenses and length of stay between the two groups:the hospitalization cost in the HIFU group was significantly less than that in the UAE group(13731.74±2194.28 VS 14471.88±1139.36 P=0.008),but there was no significant difference in hospitalization time between the two groups(P>0.05).4.Comparison of postoperative complications between the two groups:one patient in the UAE group received secondary interventional therapy because of much bleeding after discharge,and the ovarian function was premature failure after operation,while there was no significant decrease in ovarian function in the HIFU group.The incidence of postoperative abdominal pain in HIFU group was significantly less than that in UAE group(χ~2=5.361,P=0.027),but there was no significant difference in fever,nausea,vomiting,lower limb pain,numbness and hematuria between the two groups(P>0.05).5.Comparison of postoperative blood HCG recovery time,postoperative menstrual volume reduction rate and fertility status between the two groups:there was no significant difference in postoperative blood HCG recovery time,postoperative menstrual reduction rate and fertility between the two groups(P>0.05).6.Linear regression analysis showed that the average diameter of pregnancy sac(t=3.626,P=0.001),the time of menopause(t=2.437,P=0.016)and the type of CSP were the main factors affecting blood loss during uterine curettage.There was no linear correlation between other indexes and blood loss during uterine curettage(P>0.05).Conclusion:1.High intensity focused ultrasound(HIFU)ablation combined with ultrasound guided uterine curettage is effective in the treatment of scar pregnancy,and it is as effective as uterine artery embolization(UAE)combined with ultrasound guided uterine debridement.2.High-intensity focused ultrasound(HIFU)ablation combined with ultrasound-guided uterine curettage has the advantages of non-invasive,non-radiation,less co mplications,less blood loss,short operation time,low incidence of postoperative ab dominal pain,low pain score and high acceptance of patients,which provides a new CSP treatment for clinicians. |
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