| BackgroundCesarean scar pregnancy(CSP)is one of the long-term complications of cesarean section,and also one of ectopic pregnancy.The mechanism of CSP may be that the incision healed badly after labor,the scar was wider,or there were tiny holes in the scar after inflammation.In addition,when the fertilized egg developed too fast or developed slowly,it could not be planted in the process of passing through the uterine cavity,but when it arrived at the scar,it would enter the myometrium through the tiny holes and form a bed.In addition,it was dissected In addition to cesarean section,repeated abortion,hysteroscopy and other uterine operations,myomectomy,"tube baby" and other assisted reproductive technologies may cause different degrees of damage to the uterus,and scar formation in the uterus.In two child policy,cesarean scar pregnancy is a rare disease.However,with the implementation of the national second child policy,the incidence rate of CSP has been increasing year by year.The clinical manifestations of CSP have no obvious specificity,and the treatment methods are various,but there is no unified treatment method at present,but it should be based on the principle of individualized indicators and early termination of pregnancy.CSP is divided into three types.Uterine artery embolization+ultrasound-guided uterine clearance and laparoscopic scar pregnancy focus removal+terine wall repair are the main means to treat CSP at this stage.The comparison of the efficacy of CSP is the focus of our study.ObjectiveTo discuss the therapeutic effect,safety and advantages and disadvantages of uterine artery embolization+ltrasound-guided uterine clearance and laparoscopic scar pregnancy focus removal+uterine muscle wall repair on type Ⅱ and type ⅢCSP,so as to provide guidance for future clinical work.MethodsFrom January 2014 to June 2018,the clinical data of CSP patients who were treated in the Department of gynecology and obstetrics of the First Affiliated Hospital of Zhengzhou University and received uterine artery embolization+ultrasound-guided uterine cleaning and laparoscopic scar pregnancy focus removal+uterine muscle wall repair were collected,The general basic data of type II and typeⅢ CSP patients were compared,and the operation time,bleeding volume,hospitalization time,hospitalization cost,menstrual recovery time,vaginal bleeding time and human chorionic gonadotropin(hCG)time,postoperative scar condition and residual muscle layer were compared according to different groups.Results(1)There was no significant difference between the two groups in general clinical data(P>0.05),such as age,pregnancy times,times of cesarean section,time difference from the last cesarean section,days of menopause,gestational sac size,blood HCG,scar location and myometrial thickness,etc.(2)the operation time of the curettage group was significantly shorter than that of the endoscopic group,And the amount of bleeding was significantly less than that in the Endoscopy Group(P<0.05);(3)the duration of vaginal bleeding,the time of hCG recovery,the time of menstrual recovery in the endoscopy group were significantly shorter than that in the curettage group(P<0.05);(4)the length of hospitalization in the endoscopy group was shorter than that in the curettage group,and the total hospitalization cost was lower than that in the curettage group,and the difference was statistically significant.(5)The length,width and depth of scar in the endoscopic group were significantly less than those in the curettage group,and the thickness of residual muscle layer in the combined group was more than that in the curettage group,and the difference was statistically significant(P<0.05).(6)The total number of cases of adverse pregnancy in endoscopic group was significantly less than that in curettage group,and the difference was statistically significant(χ2=5.563,P<0.05).Conclusion(1)Uterine artery embolization+ltrasound-guided curettage and laparoscopic scar pregnancy focus removal+uterine wall repair are safe and effective methods to treat CSP.They all achieve the purpose of clearing the focus,retaining the fertility function and reducing complications.(2)Under the guidance of double uterine artery embolization and ultrasound,the operation has the advantages of less bleeding,less trauma,less adverse reactions,and retaining the fertility function.In the case of more bleeding and critical condition,double uterine artery embolization can be used to quickly control bleeding and stabilize the condition.(3)Laparoscopic scar pregnancy focus removal+terine muscle wall repair has the advantages of short hospital stay,complete removal of focus,fast recovery,retaining fertility function,repairing scar defects;promoting scar healing.The operation process is continuous.Under general anesthesia,patients can reduce the fear of surgery,and reduce the risk of recurrence of CSP in the long term.Therefore,it is particularly suitable In stable,type Ⅱ,type Ⅲ CSP patients,especially in type III mass type,patients with previous symptoms of menorrhagia,but need skilled surgeons to complete,and ready for conversion to laparotomy.Therefore,the two methods have advantages and disadvantages,in the treatment of patients with their own actual situation,careful choice. |
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