| Objective:To explore the clinical effect of mifepristone pretreatment combined with color doppler ultrasound-guided complete curettage of uterine cavity,hysteroscopic cesarean scar pregnancy debridement,cesarean scar pregnancy lesion debridement and scar repair in type II cesarean scar pregnancy,so as to optimize the treatment plan.Clinical data and methods:147 patients who were diagnosed as type II cesarean scar pregnancy in linyi central hospital from January 2018 to June 2022 were retrospectively analyzed.According to different treatment methods,the patients were divided into three groups: color doppler ultrasound-guided complete curettage of uterine cavity group(60cases),hysteroscopic cesarean scar pregnancy debridement group(66 cases),cesarean scar pregnancy lesion debridement and scar repair group(21 cases).Each group was divided into treatment group and control group according to whether mifepristone pretreatment was applied or not.The treatment group was operated after mifepristone pretreatment,while the control group was operated directly.The clinical effects,adverse reactions and complications of the treatment group and the control group were analyzed and compared.Results:1.There was no significant differences in age,menopause days and other clinical case information between the treatment group and the control group(P > 0.05),with comparability.2.Treatment: in color doppler ultrasound-guided complete curettage of uterine cavity group and hysteroscopic cesarean scar pregnancy debridement group,the amount of blood loss in the treatment group was significantly less than that in the control group(P < 0.05),but there was no significant difference in operation time(P > 0.05).In cesarean scar pregnancy lesion debridement and scar repair group,there was no significant difference in blood loss and operation time between the treatment group and the control group(P > 0.05).3.Postoperative parameters: in color doppler ultrasound-guided complete curettage of uterine cavity group and hysteroscopic cesarean scar pregnancy debridement group,the postoperative time of blood β-HCG negative in the treatment group was significantly shorter than that in the control group(P < 0.05),but there was no significant difference in postoperative vaginal bleeding time,menstrual recovery time,total hospitalization expenses and menstrual volume(decreased,increased and prolonged menstrual period)(P > 0.05);in cesarean scar pregnancy lesion debridement and scar repair group,there was no significant difference between the treatment group and the control group in the postoperative vaginal bleeding time,menstrual recovery time,total hospitalization expenses,postoperative blood β-HCG negative time,menstrual volume changes(menstrual volume decreased,menstrual volume increased,menstrual period prolonged)(P > 0.05);among the three groups,the total hospitalization time of the treatment group was significantly longer than that of the control group(P < 0.05).4.Success rate of treatment:There was no significant difference between the treatment group and the control group(P >0.05).Intra-group comparison: There was no significant difference between the treatment group and the control group in the treatment success rate of gestational sac diameter ≤ 3cm and > 3cm(P > 0.05).5.Incidence of adverse reactions and complications: There was no significant difference in the incidence of adverse reactions between the treatment group and the control group(P > 0.05);in color doppler ultrasound-guided complete curettage of uterine cavity group and hysteroscopic cesarean scar pregnancy debridement group,there was no significant difference in the incidence of complications between the treatment group and the control group(P > 0.05).Conclusion:1.Mifepristone pretreatment combined with color doppler ultrasound-guided complete curettage of uterine cavity can significantly reduce intraoperative bleeding,shorten the decline time of blood β-HCG,and make patients recover quickly after operation,which is more advantageous than direct operation.Mifepristone pretreatment is recommended for patients with type II cesarean scar pregnancy undergoing color doppler ultrasound-guided complete curettage of uterine cavity.2.Mifepristone pretreatment combined with hysteroscopic cesarean scar pregnancy debridement can significantly reduce intraoperative bleeding,shorten the decline time of blood β-HCG,and make patients recover quickly after operation,which is more advantageous than direct operation.Mifepristone pretreatment is recommended for patients with type II cesarean scar pregnancy undergoing hysteroscopic cesarean scar pregnancy debridement.3.Mifepristone pretreatment combined with cesarean scar pregnancy lesion debridement and scar repair for type II cesarean scar pregnancy can obviously prolong the hospitalization time,without obvious improvement in treatment success rate and obvious improvement in clinical indexes during and after operation.Mifepristone pretreatment is not recommended for patients with type II cesarean scar pregnancy undergoing cesarean scar pregnancy lesion debridement and scar repair before operation. |
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