| Objective:Through collecting the clinical data of 155 cases of uterine scar pregnancy(CSP)in the Sec ond Hospital of Jilin University,analyzing the efficacy of hysteroscopic gestational sac remova l,uterine artery embolization(UAE)+ hysteroscopic gestational sac removal,uterine scar lesion r esection + scar repair(surgical methods including laparotomy,laparoscopy,and transvaginal)in t he treatment of CSP,exploring safe and effective treatment methods for CSP,and providing refer ence for the selection of clinical CSP treatment options.Materials and methods:Clinical data of CSP patients hospitalized in the Second Hospital of Jilin University from Ja nuary 2015 to August 2020 were collected,including: 1.Preoperative general data: age,maximu m diameter of pregnancy,days of menopause,thickness of uterine scar muscle,time of last cesar ean section,number of cesarean section,serum human chorionic gonadotropin(HCG)level,natu re of pregnancy,blood flow richness around pregnancy;2.Intraoperative data: operative time an d intraoperative blood loss;3.Postoperative conditions: the degree of postoperative hemoglobi n(HGB)decline,the time required for HCG detection value to recover to non-pregnant state,th e time of menstrual return,postoperative complications,hospitalization time,and hospital expens es;4.Pregnancy outcome: pregnancy rate and recurrence rate.The clinical data of the collected p atients were complete and all met the inclusion criteria: all patients were treated for the first tim e and did not receive oral drugs or surgical treatment before admission;blood HCG concentratio n increased,and color ultrasound confirmed that it was II type CSP;the patient was generally i n good condition without uterine rupture or vaginal bleeding;previous history of lower uterine c esarean section;there is a clear history of menopause;postoperative pathology showed early pre gnancy tissue.According to different treatment methods,the 155 patients were divided into thre e groups: hysteroscopic gestational sac removal(group A),UAE+ hysteroscopic gestational sac r emoval(group B),and uterine scar lesion resection + scar repair(group C),among which,ther e were 59 patients in experimental group A(n = 59).Control group B(n = 61)and grou p C(n = 35).Statistical analysis was performed on the collected data.Resul ts:1.Preoperative general information: there were no statistically significant differences in clin ical data such as age and maximum diameter of pregnancy object among the three groups(P>0.05).There was a statistical difference in the proportion of pregnancy lesions(mass type and gestat ional cyst type)among the three groups.Stratified analysis was used to control confounding fact ors,that is,intraoperative and postoperative data of mass type and gestational cyst type in the thr ee groups were analyzed respectively.2.Intraoperative clinical data: the operative time of group C was the longest,and the differe nce was statistically significant compared with group A and B(P>0.05).Group B had the least in traoperative blood loss,and the di-fference was statistically significant compared with group A a nd C(P>0.05).3.Postoperative clinical data:(1)The HGB of group C decreased more than that of group B(P>0.05),and there was no statistical difference between group A and group C(P>0.05).(2)The time of HCG recovery to non-pregnant state in group C was the shortest in the pr egnant sac type CSP,but there was no significant difference between group C and group B in ma ss CSP(P>0.05).and the recovery time of HCG in group A was the longest,with statistical diffe rence compared with group B and group C(P<0.05).(3)The hospitalization cost of group B was the most,which was significantly different fr om that of group A and C(P<0.05).(4)The hospitalization time of group A was the shortest after the treatment of gestational sac type CSP,which was significantly different from that of group B and C(P<0.05),and the me nstrual recovery time of group B was the longest after the treatment of gestational sac type CSP,which was significantly different from that of group A and C(P<0.05).However,there was no si gnificant difference in hospital stay and menstruation recovery time among the three groups of p atients with mass CSP(P>0.05).(5)There was no significant difference in the success rate among the three groups(P>0.05).(6)Comparison of the incidence of postoperative complications among the three groups showed that the incidence of postoperative complications in group B was the highest,with statist ical difference compared with group A and group C(P>0.05).4.Pregnancy outcome: There was no statistical significance in repregnancy rate and recurre nce rate among groups A and C(P>0.05).5.The blood flow abundance around pregnancy lesions was the factor affecting the success or failure of hysteroscopic treatment of CSP(P>0.05,OR=40.507).Conclusion :1.For hysteroscopic treatment of CSP,preoperative application of UAE can reduce intraop erative blood loss,but the success rate of operation is not significantly improved,and the inciden ce of complications after UAE treatment is significantly increased.Therefore,the clinical selecti on of UAE treatment should be cautious.2.Uterine scar lesion resection + scar repair has a high success rate,but the operation tim e is long,the intraoperative bleeding is more,and the postoperative recurrence of CSP,repregnan cy rate is not significantly different from that of hysteroscopic gestational sac removal.3.Hysteroscopy alone for CSP has good safety,short operation time and hospitalization ti me,and less hospitalization cost,but requires the operator to have superb surgical techniques and rich experience.4.The abundance of blood flow around pregnancy lesions is a key factor affecting the suc cess of hysteroscopic CSP treatment.5.The choice of surgical method is not only determined by a single factor,but also requir es comprehensive analysis of the general condition of the patient,the specific condition of the di sease,the hospital conditions,the surgical techniques and experience of the operator,so as to sel ect the most appropriate treatment method. |
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