Clinical Research Of Two Methods In The Treatment Of CSP Type Ⅱ

Objective:By comparing the efficacy of uterine artery embolization(UAE)or high-intensity focused ultrasound(HIFU)before uterine aspiration in the treatment of type II of cesarean scar pregnancy(CSP),it is expected to provide guidance for its clinical treatment.Methods:The clinical data of CSP type II patients hospitalized in the gynecological ward of the Affiliated Hospital of Zunyi Medical University from January 2020 to December 2021 were collected.According to the different pretreatment methods before uterine aspiration,36 cases were divided into UAE group and 41 cases were divided into HIFU group by random number method.1.Observation indicators before treatment included age(year),type of medical insurance,pregnancy times(time),previous cesarean section times(time),time since the previous cesarean section(year),menopause time(d),whether there was vaginal bleeding and abdominal pain,whether the embryo and primitive cardiac tube pulsate were visible or not,gestational cyst volume(mm~3),blood flow resistance index(RI)around the gestational sac,residual myometrial thickness at uterine scar site(mm)and serumβ-h CG value(m IU/m L).2.Observation indicators during hospitalization included the duration of uterine aspiration(min),blood loss during uterine aspiration(m L),length of hospitalization(d),total hospitalization expenses(yuan)and the incidence of transabdominal surgery.3.Observation indicators after discharge included serumβ-h CG negative time(d),disappearance time of CSP lesions(d),vaginal bleeding time(d),first menstrual recovery time(month),ovarian function,re-pregnancy rates and outcomes,quality of life assessment.The differences of observation indexes and the total effective rate of the two groups were compared.Results:1.The total effective rate of HIFU group was higher than that of UAE group.The blood loss during uterine aspiration,the total hospitalization cost,the time to negative of serumβ-h CG,the time to disappearance of CSP lesions and the incidence of transabdominal surgery in the HIFU group were lower than those in the UAE group(P<0.05).2.The physiological and social scores of the two groups in 6 months after treatment were higher than those in 3 months after treatment.And the physiological and social scores of the HIFU group were higher than those of the UAE group at 3 months after treatment(P<0.05).3.There was no significant difference in the observation indicators,ovarian function,re-pregnancy rate and outcome between the two groups before treatment(P>0.05).Conclusion:HIFU is more effective than UAE in the pretreatment of uterine aspiration of CSP type II.HIFU has the advantages of reducing blood loss during uterine aspiration,shortening the time for serumβ-h CG to turn negative,promoting the absorption of lesions and reducing the cost of treatment.It is recommended that patients with CSP type II should choose HIFU treatment first.