Analysis Of The Related Factors Influencing The Choice Of Treatment Plan And Intraoperative Bleeding In Cesarean Scar Pregnancy

Objective:According to the clinical data of 296 CSP patients collected by CSP type,the age,menopausal time,preoperative β-hCG,the diameter of gestational sac or lesion,the thickness of scar in cesarean section incision and other clinical indicators were analyzed.The relationship between different types,different treatment methods and intraoperative bleeding volume and secondary operation rate was compared in order to provide reference for the selection of CSP treatment.Methods:A retrospective analysis was made of 296 CSP patients who first visited our hospital in January 2016 and December 2018.According to the consensus of diagnosis and treatment of CSP in 2016,combined with the ultrasound reports of our hospital,the patients in each group were divided into type I,type II and type III.Different treatment options were selected to compare the effects of CSP classification,preoperative serum β-hCG,Diameter of gestational sac or lesion on intraoperative bleeding volume.The single factor analysis of variance and test in SPSS22.0 statistical software were used to analyze the different types of CSP,the amount of intraoperative bleeding under different treatment methods,and the proportion of patients undergoing second operation.Results:1.There were significant differences in gestational sac or lesion diameter,preoperative serum β-hCG and intraoperative hemorrhage in type I、type II and type III CSP(P < 0.05).2.Type I CSP was treated by hysteroscopy,Ultrasound-monitored uterine curettage,UAE combine uterine curettage and focus resection.There was no significant difference in intraoperative bleeding volume and the incidence of secondary surgery.(P > 0.05).3.Type II CSP treated with hysteroscopy,UAE combine uterine curettage and lesion resection had significant difference in intraoperative bleeding volume(p < 0.05);UAE combine uterine curettage had less bleeding volume than hysteroscopy and lesion resection(p < 0.017);hysteroscopy had no significant difference in bleeding volume compared with lesion resection(P > 0.017).4.Type III CSP treated with hysteroscopy,UAE combine uterine curettage and lesion resection had significant difference(p < 0.05);the amount of bleeding in hysteroscopy was larger than that in combine uterine curettage and lesion resection(p < 0.017);the amount of bleeding in UAE combine uterine curettage had no significant difference compared with that in lesion resection(P > 0.017).5.There was no significant difference in intraoperative bleeding volume among different serum β-hCG and gestational sac or lesion diameters in type II CSP treated with UAE combined with uterine curettage(p > 0.05).For other treatments,there was significant difference in intraoperative bleeding volume among different serum β-hCG,gestational sac or lesion diameters(p < 0.05).6.The reoperation rate of type I,type II and type III CSP had significant difference(p < 0.05).The reoperation rate of type I CSP was low,and the reoperation rate of type II CSP and type III CSP was high.7.The reoperation rate of type II and type III CSP treated by hysteroscopy,UAE combined with hysterectomy and focal resection had significant difference(p < 0.05),and the reoperation rate of hysteroscopy was higher.8.The incidence of surgical complications of the four treatments was significantly different(p < 0.05).The incidence of complications of UAE combined with uterine curettage was significantly different from that of other three operations(p < 0.013).All complications could be recovered in a short time.Conclusions:1.Type I CSP has no difference among the four treatments.。Ultrasound-monitored uterine curettage or hysteroscopy are commonly used in clinic.2.Type II CSP gestational sac or lesion diameter < 3 cm,serum β-hCG < 30 000 mIU/mL,UAE combined with uterine curettage has the least bleeding during operation,but has more complications.Hysteroscopy and focus resection have no significant difference in treatment effect.Hysteroscopy is the most widely used method in technology promotion and clinical application.3.Type II CSP with gestational sac diameter ≥3 cm,serum β-hCG≥ 30 000 mIU/mL and type III CSP,hysteroscopy has a high risk of bleeding and a high chance of reoperation.UAE combine uterine curettage or lesion resection is recommended.