Comparison Of Two Surgical Methods For Excision Of Pregnancy Focus With Cesarean Scar

Objective: To investigate the clinical characteristics of Cesarean scar pregnancy,and compare the characteristics,curative effect and outcome of laparoscopic and transvaginal hysterectomy for Cesarean scar pregnancy.Methods: The clinical data of 50 patients with exogenous CSP admitted to the Second Affiliated Hospital of Anhui Medical University from September 2013 to August 2019 were analyzed retrospectively.According to different treatment methods,patients were divided into two groups: Group A and Group B,group A was treated with laparoscopic resection and repair of pregnancy lesions,and Group B was treated with transvaginal hysterectomy and repair of uterine scar lesions.Data were analyzed with SPSS 16.0,the clinical characteristics,operation time,intraoperative bleeding,hospital stay,hospital expenses,postoperative menstrual recovery and reproduction were compared between the two groups.Results:(1)All the patients were diagnosed as Cesarean scar pregnancy by transvaginal color doppler ultrasound or transabdominal color doppler ultrasound.There were 23 cases of cicatricial pregnancy admitted to hospital after drug-induced abortion or curettage.In all patients,villous tissue was seen in the intraoperative lesions,or the postoperative pathology suggested pregnancy tissue,which accorded with the diagnosis of Cesarean scar pregnancy.(2)The general data(including age,menopause time,pregnancy times,birth times,Cesarean section times,interval from previous Cesarean section,abortion times,blood-HCG level at admission,average diameter of gestational sac or lesion)of the two groups were compared by independent t test,the results showed that there was no significant difference between the two groups(P>0.05).The two groups were comparable in terms of treatment.(3)There was no significant difference in the amount of intraoperative bleeding and hospitalization time between the two groups(P>0.05),but it can obviously shorten the operation time and reduce the cost of hospitalization(P<0.05).(4)2-3 days after operation,the overall blood-HCG level in both groups decreased significantly,the success rate of Group A(via laparoscopy)was 100%,and that of group B(transvaginal surgery)was 95%.The difference was statistically significant(P<0.05).(5)The patients with CSP had low need for reproduction,the natural pregnancy rate was 80%,and the pregnancy outcome was good,but there was a risk of recurrent CSP.Conclusion: Laparoscopic or transvaginal hysterectomy with scar excision and repair is an effective surgical approach for CSP,which can effectively preserve the fertility of patients,and the latter can effectively shorten the operation time and reduce the hospital costs,but the former is safer and more reliable.