The Clinical Value Of Laparoscopic Surgery In The Treatment Of Cesarean Scar Pregnancy

Objective: Due to the high rate of cesarean section worldwide, so that the increasing incidence of cesarean scar pregnancy(CSP). The exact cause of the disease is unknown, there is no plan of treatment options. There is not specific clinical features for CSP, in clinical, it is easily misdiagnosed as cervical pregnancy, inevitable abortion or incomplete abortion and so on. Oftenly, due to improper handling leads to bleeding, uterine rupture and secondary infection dangerous complications, the final result is difficult to control the bleeding and hysterectomy. Therefore, early diagnosis clear CSP and giving safe and reasonable approach, can effectively reduce the incidence of complications. The purpose of this experiment is to the clinical value of laparoscopic surgery for CSP.Method: Retrospective analysis, 10 cases of the cesarean scar pregnancy were selected from The Fourth Hospital of Hebei Medical University during March 2012 to April 2015, selected laparoscopic the bilateral uterine artery occlusion surgery + Scar Embryonic tissue removal surgery + Scar excision +lower uterine segment scar neoplasty for the experimental group, and 20 cases of the same patients diagnosed adopted traditional laparotomy: Cesarean section fetal surgery + lower uterine segment scar neoplasty as the control group. 30 cases were the first diagnosed of exogenous CSP and stable condition. The patients of two groups were observed, Compared the operation time, intraoperative blood loss, the time of postoperative serum β-h CG recovery normal, postoperative complications, hospital stays, hospital fees and so on related situation.Statistical analysis was finished by SPSS19.0. Measurement data were normally distributed test and homogeneity of variance test, if the data meet the normal distribution and homogeneity of variance,the independent sample t text, each set of data is represented by-x ± s; Normality is not satisfied with the median represented using Mann-Whitney U test; Enumeration data were compared with fourfold table chi-square test. a = 0.05(bilateral) as the test level, P <0.05 was considered statistically significant.Results: 1 The difference of two groups of patients’ basic information :The comparison of two groups of patients’ age, pregnancies, cesarean time sand from the last cesarean section basic information was not statistically significant(P>0.05). Table1; 2 The difference of two groups of patients’ preoperative situation: This study is the initial treatment of cases, and the gestational sac are convex to the serosa growth exogenous CSP.The comparison of two groups of patients’ the time of menopause, gestational sac size, thickness of the muscle scar and the initial serum β-h CG value related preoperative information was not statistically significant(P>0.05). Table 2; 3 Intraoperative and postoperative conditions:3.1 The difference of two groups of patients’ operation time and Intraoperative blood loss: The experimental group of patients’ operative time was 50(40~90)min, Intraoperative blood loss was 15(5~40)ml; the control group of patients’ operative time was 80(60~120)min, Intraoperative blood loss was 50(10~800)ml. Compared the two groups, the experimental group of patients’ operative time was shorter and the Intraoperative blood loss was less, the difference was statistically significant(P<0.05). Table 3;3.2 The difference of two groups of patients’ the serum β-h CG values of first day after surgery and β-h CG decline rate: The experimental group of patients’ the serum β-h CG values and serum β-h CG mean decline rate of the first day after surgery were 22972(13466~27798)m IU/ml,(68.8±3.49)%; the control group of patients’ the serum β-h CG values and serum β-h CG mean decline rate of the first day after surgery were 21972(5628~28547)m IU/ml,(68.9±3.31)%, Compared the two groups, the difference was not statistically significant(P>0.05). Table 4;3.3 The difference of two groups of patients’ postoperative exhaust time and postoperative ambulation time :The experimental group of patients’ postoperative exhaust time was 1(1~2) d, the control group of patients’ postoperative exhaust time is 2(2~3) d; the experimental group of patients’ postoperative ambulation time was 1(1~2) d, the control group of patients’ postoperative ambulation time was 3(2~4) d, the comparison of the data result of two groups was: the experimental group of patients’ postoperative exhaust time and postoperative ambulation time was shorter than the control group of patients’, the difference was statistically significant(P<0.05). Table 5; 3.4 The difference of two groups of patients’ postoperative complications: The experimental group that was laparoscopic group had no serious complications, the control group that was laparotomy group had complication, including postoperative fever(body temperature is still around 38.5 after surgery 48 h, In addition to leukocytosis, the other laboratory tests showed no abnormalities) 2cases, 1cases of abdominal incision liquefaction. Compare two groups of data, P=0.5032>0.05(Fisher’s Exact Text),there was a significant difference in the number of complications. Table 6;3.5 The difference of two groups of patients’ hospital stays hospital fees: The experimental group of patients’ hospital stays was 4(3~5)d and mean hospital fees was(16374±675.63)yuan; the control group of patients’ hospital stays and mean hospital fees was 6(5~8)d,(11541.6±1225.41)yuan. The results between the two groups: the experimental group of patients’ hospital stay is shorter, the difference was statistically significant(P<0.05); but the experimental group of patients’ hospital fees is higher than the control group patients’, the difference was statistically significant(P<0.05). Table 7;3.6 The difference of two groups of patients’ postoperative follow-up: The experimental group of patients’ the time of postoperative serum β-h CG recovery normal 14(14~21)d, the time of menstrual cramps 30(25~38)d; the control group of patients’ the time of postoperative serum β-h CG recovery normal 14(14~35)d, the time of menstrual cramps 32(28~60)d. The results between the two groups, the experimental group of patients’ the time of postoperative serum β-h CG recovery normal,the time of menstrual cramps and that required in the control group of patients’, the difference was not statistically significant(P>0.05). Table 8;After 3 months after vaginal ultrasound results, the experimental group that is laparoscopic surgery and control group namely the traditional laparotomy surgery of patients’ lower uterine segment scar mass disappeared and healed well. After 6 months later, all patients had normal menses, the experimental group of patients with no obvious discomfort complained; the control group of patients 2 patients had abdominal discomfort, did not affect normal life, so did not given special treatment;3.7 The difference of two groups of patients’ success rates: The experimental group of 10 patients were successfully during surgery, no laparotomy, including one patient ’ left uterine artery permanently blocked intraoperative, the cases of patients who first laparoscopic surgery for CSP, less experience in due to the separation of the left uterine artery bleeding more surgical field blur, so take bipolar coagulation of uterine artery. In the control group that was traditional laparotomy surgery group, one patient was 33 years old, the time of menopause 76 days, 7 days for treatment of vaginal bleeding profusely, vaginal B super results showed: anterior uterine incision explored 5.47cm×5.11 cm × 4.6cm not rule gestational sac echo, about 1/3 of the gestational sac extruded surface of the uterus, visible embryo echo, beating heart tube, the remaining meager muscle can not be measured. Due to pregnancy sac engorgement of blood vessels visible on the surface shape, less elastic blood vessels, in surgery,cut the gestational sac direct process more bleeding, so permanent occlusion of the uterine artery, blood loss amounted to 800 ml, 6 units of red blood cell + 200 ml of plasma + cryoprecipitate 20 units were infused, and ultimately keep the uterus. All patients recovered well and were discharged, two groups of patients’ success rates was no difference.Conclusion: For exogenous CSP treatments, this subject summarizes the characteristics of laparoscopic surgery:1 temporarily blocking the uterine artery, reduce blood loss, and postoperative can fully recover the uterus and ovary blood supply, to maintain its normal physiological function;2 the muscle wall injection of vasopressin, to promote uterine contractions and reduce the local muscle blood flow;3 bipolar coagulation mass surrounding vascular engorgement, in order to reduce bleeding;4 ahead of the need to draw the outline of scar removal, to ensure cutting edge tidy;5 gestational sac removed intact tissue, as attractors Wash tissue surrounding decidua;6 full-thickness incisions, before closing basin peritoneum;Laparoscopic surgery in the treatment of CSP is safe and effective, quick recovery, side effects, worthy of promotion.