Clinical Analysis Of Two Surgical Methods In The Treatment Of Interstitial Tubal Pregnancy

Part Ⅰ Clinical Analysis of 13 Cases of Interstitial Pregnancy Treated by Hysteroscopy under B-ultrasound MonitoringObjective: To explore the clinical indications,therapeutic effect and prognosis of hysteroscopy for tubal interstitial pregnancy under B-ultrasound supervision.Methods: Retrospective analysis the clinical data of 13 patients who were diagnosed with interstitial pregnancy in Affiliated Hospital of Zunyi Medical University from January,2015 to July,2020,and the patients were fully informed and selected hysteroscopy under B-ultrasound supervision as treatment for interstitial pregnancy.The preoperative indicators were analyzed as follows: time to menopause(days),whether underwent curettage before hysteroscopy,mass size(cm),preoperative blood β-HCG(mi U /m L),and muscular thickness(cm).Intraoperative indexes: operation time(min),intraoperative blood loss(ml).Postoperative indicators:postoperative blood β-HCG(MIU /m L),length of hospital stay(days),persistence of ectopic pregnancy,whether there were fertility requirements,postoperative pregnancy,postoperative gestation time(months),pregnancy outcome.Results: Preoperative indicators of the 13 patients: median menopause time: 81 days;Preoperative curettage was performed in 10 patients.The median of the maximum diameter of preoperative pregnancy mass was 2.3cm;The median of preoperative blood β-HCG was639ml;The median of muscular thickness was 0.3cm.Intraoperative indicators: Median of operative time: 20.0min;The median of blood loss was 50.0ml.Postoperative measures:Median of hospital stay: 4 days;Mean time for blood β-HCG to decrease to normal: 1.77 weeks.4 patients had fertility requirements after surgery,and the gestation time last from 5months to 1 year after surgery.5 patients got pregnant successfully after surgery,and 1 of them was aborted due to unplanned pregnancy,and 1 patient underwent medical abortion due to embryo cessation.Two patients had full-term vaginal delivery,and one patient had full-term cesarean delivery.The newborns were all healthy.Conclusion: Hysteroscopy can be performed under B-ultrasonography when the local muscular thickness(≥0.2cm)in the tubal interstitium of pregnancy while meets at least one of the two conditions as follows: short pregnancy mass diameter(≤4cm)and low blood β-HCG(≤2000m IU/m L).Part Ⅱ Clinical Analysis of Two Surgical Methods in the Treatment of Interstitial Tubal PregnancyObjective: To explore the clinical effeciency of two surgical methods in the treatment of interstitial tubal pregnancy.Methods: Retrospective analysis the clinical data of interstitial tubal pregnancy cases diagnosed in Affiliated Hospital of Zunyi Medical University during January 2015 to July2020 with local muscular layer ≥0.2cm that had presever fallopian tubes,while meets at least one of the following items,pregnancy mass diameter ≤4cm and blood β-HCG≤2000m IU/m L.According to surgical methods,the patients were divided into hysteroscopy group and laparotomy group,and the preoperative indicators of the two groups were compared,such as:gestation days,preoperative blood β-HCG,the maximum diameter of mass,pelvic effusion volume,muscular thickness,local IR.Intraoperative indicators: operative time,intraoperative blood loss.Postoperative indicators: time for blood β-HCG to reduce to normal,hospital stay,and postoperative pregnancy.Results: Preoperative indicators: Compared with the laparotomy group,there were no significant differences in gestation days,preoperative serum β-HCG,mass maximum diameter,pelvic effusion volume,muscular thickness and local IR value in hysteroscopy group(P >0.05).Intraoperative indicators: Compared with laparotomy group,the operation time of hysteroscopy group was shorter,and the difference was statistically significant(P < 0.05),while there was no significant difference in intraoperative blood loss(P > 0.05).Postoperative indicators: Hospital stay in hysteroscopy group was shorter than that in laparotomy group,the diffference was statistically significant(P < 0.05).There was no significant difference in time for blood β-HCG to reduce to normal and pregnancy status in two groups(P > 0.05).Conclusion: When the thickness of the local muscular layer in the interstitial pregnancy is≥0.2cm,and meets at least one of the following terms,diameter of pregnancy mass≤4cm and blood β-HCG≤2000m IU/m L,B ultrasound monitoring hysteroscopic treatment is one of an effective surgical procedures compared to laparotomy operation,with the advantages of minor damage and faster fertility recovery,shorter operation time and hospital stay.