| Objective:This research was carried out to analyze and compare the different approaches to the treatment of cesarean section scar pregnancy.Method:Data of the patients with cesarean scar pregnancy who were admitted to our hospital during the year of 2016 was collected.These 274 patients were divided by surgical ways into 4 group.Group A:Uterine curettage group with 193 cases.Group B:Curettage combined with uterine artery embolization group with 74 cases.Group C:Hysteroscopy group with 2 cases.Group D:Transabdominal surgery group with 5 cases.Comparisons were made on the gestational age,the thickness of the intervening myometrium between the gestation sac and the bladder,perfusion surrounding the gestation sac,intraoperative bleeding volume,preoperative levels of human chorionic gonadotropin,human chorionic gonadotropin clearance rate,hospitalization cost and so on between the former two groups.Results:Type Ⅰ cesarean scar pregnancy is accounting for 34.0%,type II cesarean scar pregnancy is accounting for 57.6%,type III cesarean scar pregnancy is accounting for 8.4%.The patients with cesarean scar pregnancy who were admitted for the results of Doppler ultrasound account for 39.4%of the total,the admitted for vaginal bleeding account for 48.5%,the patients admitted for abdominal pain account for 3.7%,the patients admitted for vaginal bleeding with abdominal pain account for 2.2%,the patients admitted for the requirements of termination of pregnancy account for 3.7%.Group A:The treatment of these cesarean section scar patients were successful.There is no intraoperative complications.The patients whose gestational ages were not more than 7 weeks accounte for 59.6%.The patients whose CSP sac volumes were not more than 2.5cm*2.5cm*2.5cm accounte for 61.5%.The patients whose thicknesses of the intervening myometrium between the gestation sac and the bladder were not less than 3mm accounte for 47.2%.The patients whose perfusions surrounding the gestation sac were not abundant accounte for 65.2%.The mean preoperative level of HCG was(40342±45897)IU/L.The patients whose intraoperative bleeding volume were not more than 100ml accounte for 96.9%.The mean HCG clearance rate was(67.0±11.2)%.The mean postoperative hospital stay time was(4.5±1.6)days.The mean hospitalization cost was(3489.1 ± 2258.1)yuan.The patients who were admitted to the hospital again accounte for 3.1%.Group B:The treatment of these cesarean section scar patients were successful.The patients who suffered from the intraoperative complications accounte for 39.2%.The patients whose gestational ages were not more than 7 weeks accounte for 43.2%.The patients whose CSP sac volumes were not more than 2.5cm*2.5cm*2.5cm accounte for 30.6%.The patients whose thicknesses of the intervening myometrium between the gestation sac and the bladder were not less than 3mm accounte for 17.6%.The patients whose perfusions surrounding the gestation sac were not abundant accounte for 22.5%.The mean preoperative level of HCG was(69257±59676)IU/L.The patients whose intraoperative bleeding volumes were not more than 100ml accounte for 91.9%.The mean HCG clearance rate was(73.9±11.2)%.The mean postoperative hospital stay time was(6.4±1.9)days.The mean hospitalization cost was(12230.8±1624.6)yuan.The patients who were admitted to the hospital again accounte for 8.1%.Group C:The treatment of these cesarean section scar patients were successful.The patients who suffered from the intraoperative complications accounte for 100%.The patients whose gestational ages were not more than 7 weeks accounte for 50%.The patients whose CSP sac volumes were not more than 2.5cm*2.5cm*2.5cm accounte for 50%.The patients whose thicknesses of the intervening myometrium between the gestation sac and the bladder were not less than 3mm accounte for 0%.The patients whose perfusions surrounding the gestation sac were not abundant accounte for 50%.The mean preoperative level of HCG was(59395.5±77110.7)IU/L.The patients whose intraoperative bleeding volumes were not more than 100ml accounte for 100%.The mean HCG clearance rate was(68.3± 19.7)%.The mean postoperative hospital stay time was(4.5±0.7)days.The mean hospitalization cost was(10125±4748.9)yuan.The patients who were admitted to the hospital again accounte for 0%.Group D:The treatment of these cesarean section scar patients were successful.The patients who suffered from the intraoperative complications accounte for 80%.The patients whose gestational ages were not more than 7 weeks accounte for 0%.The patients whose CSP sac volumes were not more than 2.5cm*2.5cm*2.5cm accounte for 0%.The patients whose thicknesses of the intervening myometrium between the gestation sac and the bladder were not less than 3mm accounte for 0%.The patients whose perfusions surrounding the gestation sac were not abundant accounte for 40%.The mean preoperative level of HCG was(75098.5±20426.2)IU/L.The patients whose intraoperative bleeding volumes were not more than 100ml accounte for 20%.The mean HCG clearance rate was(90.6±1.4)%.The mean postoperative hospital stay time was(9.2±3.6)days.The mean hospitalization cost was(24112.8±3639.7)yuan.The patients who were admitted to the hospital again accounte for 0%.The difference of gestational ages,CSP sac volumes,the thicknesses of the intervening myometrium between the gestation sac and the bladder,perfusions surrounding the gestation sac,preoperative levels of HCG,HCG clearance rates,intraoperative complications,postoperative hospital stay time,hospitalization cost between the group A and group B had statistical significance(P<0.05).And There was no statistically significant difference of intraoperative bleeding volumes and Re-admission ratio between the two groups(P>0.05)Conclusion:Uterine curettage is more suitable for the patients whose gestational ages were not more than 7 weeks,or the CSP sac volumes were not more than 2.5cm*2.5cm*2.5cm accounte for 30.6%,or the intervening myometrium between the gestation sac and the bladder were not less than 3mm,or the perfusions surrounding the gestation sac were not abundant,or the mean preoperative level was low.On the contrary,curettage combined with uterine artery embolization is more suitable for the patients whose gestational ages were more than 7 weeks,or the CSP sac volumes were more than 2.50cm*2.50cm*2.50cm accounte for 30.6%,or the intervening myometrium between the gestation sac and the bladder were less than 3mm,or the perfusions surrounding the gestation sac were abundant,or the mean preoperative level was high. |
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