| PurposeTo explore the clinical value of uterine artery embolization(UAE)pretreatment in hysteroscopic surgery for type II scar pregnancy(CSP).And to evaluate the safety and effectiveness of hysteroscopic surgery,and to provide clinical basis for finding a simpler,convenient and economical CSP treatment method.MethodologyA total of 76 patients of scar pregnancy treated by hysteroscopy in our hospital from January 2018 to June 2019 were selected as observation objects.All the selected cases were confirmed to be type II scar pregnancy by gynecologic color Doppler ultrasound in our hospital(according to "Expert Consensus on Diagnosis and Treatment of Uterine Scar Pregnancy after Cesarean Section"),and the clinical data were complete.All the cases were confirmed to be pregnancy by pathological diagnosis after operation.Among them,those who underwent hysteroscopy after pretreatment of uterine artery embolization were the observation group(n=29)and those who underwent hysteroscopy alone were the control group(n=47).The intraoperative blood loss,blood transfusion,compression balloon,preoperative and postoperative blood routine,HCG value,operation time,hospitalization time,total hospitalization expenses and complications were compared between the two groups.The differences between the two groups were compared statistically.Results1..General clinical data: average age,gestational age,parity,median gestational age,median time from previous cesarean section,median pregnancy mass diameter,thinnest myometrium thickness at median uterine scar and median preoperative serum HCG of observation group and control group.The mean hemoglobin levels beforeoperation were 33.86 and 33.45 d,3.98 and 3.97 times,1.48 and 1.40 times,46 and 45 days,5 and 4y,3.4 and 2.8cm,0.3 and 0.3cm,59288.84 and 43541.23mIU/L,125.24 and 127.09g/L,respectively,with no significant difference(all P > 0.05).2.Intraoperative conditions: All 76 patients successfully completed hysteroscopic surgery,and none were converted to laparotomy or laparoscopy.The intraoperative blood loss and the median hysteroscopic operation time of the observation group and the control group were 20(7.5,30)and 20(15,50)mL,20 and 25 min respectively,with statistically significant differences(all P < 0.05),but in the balloon compression rate,hemoglobin content changes before and after operation,blood transfusion rate and the incidence of intraoperative blood loss ? 200 mL,the two groups were 6.8% and10.6%,13.93 and 15.34g/L,3.4% and 6.3%,3.4% and 6.3%,respectively,with no statistically significant differences(all P > 0.05).3.postoperative recovery:100%(29/29)and 97.9%(46/47)of the observation group and the control group were cured by initial hysteroscopy respectively.the initial cure rate was not statistically significant(P = 0.265 > 0.05).The decrease of HCG in blood on the 2nd day after operation was significantly greater in the observation group(90.59%)than in the control group(84.00%)(P = 0.012 < 0.05),while the decrease of HCG in blood on the1 st day after operation,the performance of color Doppler ultrasonography after operation and the recovery time of menstruation were compared respectively,with no significant difference(all P > 0.05).4.postoperative complications: the median score of postoperative body temperature and pain in the observation group,the proportion of patients with body temperature ?38? and patients with obvious pain were higher than those in the control group,the difference was statistically significant(all P < 0.05).There were 3 patients(10.3%,3/29)and 1 patient(2.1%,1/47)of amenorrhea in the two groups respectively.the difference between the two groups was statistically significant(P = 0.047 < 0.05),and the incidence rate in the observation group was higher.5.Discharge status : the average hospitalization time of the observation group and the control group were 5.72 and 4.23 d respectively,and the median hospitalization expenses were 38705 and 9226.69 yuan respectively.the differences were statistically significant(P < 0.05).Conclusions1.UAE can effectively reduce intraoperative hemorrhage and operation time,but the amount of intraoperative hemorrhage in hysteroscopic surgery alone is within a safe range,and the amount of intraoperative hemorrhage ?200ml,blood transfusion rate,hemoglobin difference before and after surgery and balloon compression rate during surgery have no significant difference;2.UAE can accelerate the decrease of blood HCG,which is beneficial to the recovery of blood HCG after operation,but has no significant effect on menstrual recovery.Moreover,with the maturity of hysteroscopy,there is no significant difference between the effect of hysteroscopy alone and that of UAE pretreatment.3.Obvious complications such as pain and fever are more likely to occur after UAE.The probability of amenorrhea is obviously increased.4.UAE significantly prolonged the hospitalization days of patients,increased the economic burden of patients,and had no obvious effect in increasing the initial cure rate5.Generally speaking,UAE has certain advantages in the treatment of CSP.Hysteroscopic treatment after UAE has the advantages of less trauma and quick recovery in the treatment of type II scar pregnancy,but it is expensive,long in hospital stay and more postoperative complications of patients.Compared with hysteroscopic surgery alone,it has no significant advantages,and its clinical application depends on the patient's condition. |
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