| Objective:Cesarean scar pregnancy is a common complication of Obstetrics and gynecology.At present,we can choose the treatment: Ultrasound-guided uterine cleaning,interventional therapy assisted uterine cleaning,abdominal(mostly under the uterus,laparoscope)or vaginal cesarean scar excision + repair.Because interventional therapy and laparoscopic surgery need special equipment and personnel,basic hospitals often can not implement,there are certain limitations.The purpose of this study is to summarize and analyze the application of ultrasound-guided hysterectomy and transvaginal cesarean scar excision in CSP,so as to provide an objective basis for the selection of safe and effective diagnosis and treatment scheme of CSP in basic hospitals.Methods:The clinical data of 120 cases of CSP in our hospital from April 2015 to August 2019 were analyzed retrospectively.According to the relationship between pregnancy tissue and scar,CSP was divided into complete type,partial type and marginal type.According to the ultrasonic measurement of the thickness of the scar in the lower segment of the uterus,the operation methods were selected,which were the uterine cleaning operation group and the vaginal operation group.The thickness of the lower segment of the uterus is less than or equal to 2 mm.38 cases were treated by excision and repair of the pregnancy site of vaginal scar,including 18 cases of partial type and20 cases of complete type.82 cases(55 cases of marginal type,34 cases of partial type and 11 cases of complete type)of CSP with the thickness of more than 2 mm in the marginal type and the lower segment of uterus were treated by ultrasound-guided uterine cleaning.According to the intraoperative bleeding,it is necessary to assist with balloon compression hemostasis.The clinical data of all patients were analyzed,and the days of menopause,the position relationship between pregnancy tissue and scar,the thickness of scar,the time of two kinds of operation,the amount of bleeding during operation,the time of blood β-h CG turning negative after operation,the time of hospitalization after operation,the cost of treatment were compared.The time ofmenstrual recovery and the outcome of second pregnancy were followed up.Carry out statistical analysis.Results:1)There were no significant differences in the three types of 120 patients,including the days of menopause,the time of β-h CG turning negative and the time of menstruation resuming(P>0.05).2)In 55 cases of borderline type,ultrasound-guided curettage was performed,in which 2 cases were assisted by balloon compression.Among 34 cases of partial type,16 cases had scar thickness > 2 mm,3 cases had assisted balloon compression,18 cases had scar thickness ≤ 2 mm.In 31 cases of complete type and 11 cases of scar thickness > 2 mm,hysteroscopy was performed under the guidance of ultrasound,among which 10 cases were given assistant balloon compression hemostasis due to intraoperative hemorrhage.20 cases with scar thickness less than or equal to 2 mm were treated with vaginal operation.The results showed that according to the grouping of ultrasound and the thickness of uterine scar,it can guide the clinical choice of operation plan,and its safety is reliable.3.Among the 65 cases of partial type and complete type,27 cases with scar thickness > 2 mm,38 cases with scar thickness ≤ 2 mm and 38 cases with vaginal operation were selected.There was no statistical difference between the two groups(P > 0.05).1)Comparison of intraoperative bleeding volume:(1)in the Qinggong operation group:partial type: average bleeding volume(36.62 ± 24.32)ml;(2)complete type: average bleeding volume(116.27 ± 70.35)ml,the difference was statistically significant(P <0.01).None of the above patients had blood transfusion,conversion to laparotomy or hysterectomy,and no blood transfusion was needed due to intraoperative hemorrhage.Because of the deep implantation range,rich blood supply,high risk of bleeding during operation and the scar thickness of more than 2mm,the application of balloon compression hemostasis can achieve hemostasis.The data showed that although the bleeding volume of vaginal operation was more than that of uterine cleaning operation group,the bleeding volume caused by tissue separation during operation should be considered in the total bleeding volume.2)The hospital stay was(2.43 ±0.37)days in the operation group and(2.02 ± 0.17)days in the operation group.There was no significant difference between the two groups(P = 0.37);3)the operationtime of the two groups was(16.52 ± 1.67)min in the vaginal operation group and(40.74 ± 2.02)min in the uterine cleaning group.The difference between the two groups was statistically significant(P < 0.01).4)The treatment costs of the two groups were compared: 8163.31 ± 179.15 yuan in the vaginal operation group,(2971.61 ± 76.00)yuan in the Qinggong operation group.The treatment costs of the vaginal operation group were higher than that of the Qinggong group,and the difference was statistically significant(P < 0.01).5)The comparison of the incidence of intraoperative bleeding between the two groups: the incidence of intraoperative bleeding was 0% in the vaginal operation group and 48% in the uterine cleaning operation group because of intraoperative bleeding.The difference was statistically significant(P < 0.01).Conclusion:According to the above statistical data analysis,transvaginal ultrasound can clearly classify CSP,judge the thickness of muscle layer,and provide the basis for the choice of treatment.Therefore,for the measurement of scar thickness greater than 2 mm,the choice of ultrasound-guided uterine cleaning,no case of conversion to open surgery due to massive hemorrhage,no need for blood transfusion.For complete CSP and partial CSP,the thickness of scar measured by ultrasound is less than or equal to 2mm,and the pregnancy focus of scar is removed and repaired by vagina,which can not only reduce the risk of bleeding,but also repair the defect of original scar.In the treatment of CSP,the curative rate can reach 100% by transvaginal hysterectomy plus repair.It has the advantages of short operation time,less intraoperative bleeding,high safety,small trauma,small economic burden and quick recovery after operation.At the same time,the requirements for surgical equipment and personnel are relatively low,which is worthy of clinical promotion in grass-roots hospitals. |
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