| Objective:To analyze the influencing factors of Cesarean scar pregnancy(CSP)and the clinical data characteristics of different types of CSP patients,in order to reduce and prevent the occurrence of CSP,summarize the diagnosis and treatment,and to provide theoretical basis for the individualized treatment.Methods:A retrospective study was carried out through the clinical data of 207 patients with CSP in the first teaching hospital of Jilin university obstetrics and gynecology from January 2009 to December 2016 as an experimental group,and randomly selected 207 cases of normal pregnancy after cesarean section in patients with clinical data as the control group.SPSS software was used for statistical analysis,risk factors the pathogenesis of CSP,could help to prevent high-risk groups.According to the expert consensus of diagnosis and treatment of CSP were put forward by Chinese medical association in 2016,207 cases of patients with CSP can be divided into three types.The application of the clinical data results of patients with different CSP types were statistically analyzed in SPSS software,to summarizes the law of diagnosis and treatment,to provide a reference for clinical diagnosis and treatment of different types of CSP patients.Results:1.From January 2009 to December 2016,there were 207 cases of CSP patients in the first teaching hospital of Jilin university obstetrics and gynecology,including 120 cases of CSP?,accounting for 57.97%;22 cases of CSP?,accounting for 10.63%;65 cases of CSP ?,accounting for 31.40%.In 8 years,the number of CSP patients in our hospital showed an upward trend as a whole,the proportion of the CSP?and CSP was increasing,the proportion of ? CSP ? was decreasing.2.The age of 207 patients with CSP was normal distribution.In the study of patients age,the proportion of patients who is younger than 25 years is 11.60%,and 63.77% of patients aged from 26 to 35 years.The patients aged 36 to 40 accounted for 17.87%.Patients aged 40 accounted for 6.76%.This shows that about 2/3 of CSP patients are between 26 and 35 years old.3.This study,according to single factor analysis(P< 0.05 for the inspection level),according to the results of pregnancy times,abortion times and previous cesarean delivery hospital level and other factors related to the occurrence of CSP.Through multi-factor analysis,the number of pregnant is equal or greater than 3,the number of abortions is equal or greater than 2 and the previous cesarean section hospital as non-tertiary hospital are risk factors of CSP.It shows that the risk of CSP is greater than 3 times.If the number of abortion is equal or greater than 2 times,the risk of CSP is greater.Previous cesarean section hospital level is non-tertiary hospital,the risk of CSP is greater.4.207 cases of CSP had menolipsis,the shortest time was 30 days,the longest was 129 days,the average menopause days was 56.29±15.966 days.The number of menopause days of CSP?was 51.27±11.34 days,the number of days in CSP was ?54.36±14.11 days,and the number of days in CSP ?was 66.00±19.31 days.The number of menopause days in three groups of CSP patients,the difference was statistically significant.There was no significant difference between CSP?and CSP?.The difference of three groups between CSP?and CSP ?was statistically significant.The difference of three groups between CSP ?and CSP ?was statistically significant.It shows that the number of menopause days of CSP ?may be longer than CSP?and CSP?.5.The mean value of ultrasound measurement in 207 cases of CSP was 32.46±18.938 mm,and 1 case was rich in blood flow signal in cesarean scar only,the maximum value was 105 mm.The diameter of the lesion in CSP?was 26.51±14.81 mm,the diameter of the lesion in CSP?was 26.86±13.96 mm,and the diameter of the lesion in CSP ?was 45.63±20.52 mm.The difference of ultrasound celiangbing in three groups of different types of CSP was statistically significant.There is no significant difference between CSP?and CSP?,compared with CSP?,CSP and ? CSP?,it indicates that the diameter of the lesion of CSP?and CSP is ?larger than that of CSP?.6.207 cases of CSP had cardiac fetal heart in 64 cases and no fetus in 143 cases.The proportion of fetal heart rate in three groups of different types of CSP was analyzed statistically,the difference was statistically significant(P<0.05).The proportion of the fetal heart in CSP?is larger than that in CSP? and CSP?,and the proportion of heart in CSP is? n't larger than that in CSP?and CSP?.7.Main clinical manifestations of 207 patients with CSP for painless vaginal bleeding after menopause,without any clinical symptoms,the abdominal pain with postmenopausal vaginal bleeding after miscarriage,vaginal bleeding and abdominal pain without vaginal bleeding after menopause.The painless vaginal bleeding after menopause proportion is the largest.8.The treatment methods of the patients with CSP?and CSP ?were treated with drug pretreatment(MTX / mifepristone)and hysteroscopic cesarean scar parts under hysteroscopy.The treatment method of CSP ?patients was the most of the treatment of uterine artery embolization and hysteroscopic cesarean section embryo tissue excision.9.207 cases of CSP patients were less than or equal 500 m IU/ml of serum h CG,the treatment method chose the ultrasonic monitoring group or cesarean section scar part of cesarean section mainly.At admission,the serum h CG is greater than 500 m IU/ml,the treatment method selected the drug pretreatment(MTX / mifepristone)and hysteroscopic cesarean section embryo tissue excision.Conclusion:1.The overall increase of the number of patients in the period from 2009 to 2016,in which the increase of the CSP I and CSP yield is more significant.?2.The number of pregnant is equal or greater than 3,the number of abortions is equal or greater than 2 and the previous cesarean section hospital as non-tertiary hospital are risk factors of CSP.3.The clinical manifestations of the CSP is given priority to with painless vaginal bleeding after menopause.4.The combination of CSP typing and serum h CG levels has important clinical significance for individual treatment options in patients with CSP. |
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