Clinical Comparative Study Of High Intensity Focused Ultrasound Ablation In Patients With Cesarean Scar Pregnancy

Objective:To analyze the clinical efficacy of high intensity focused ultrasound(HIFU)ablation in the treatment of cesarean scar pregnancy(CSP).At the same time,the patients who were treated with uterine artery embolization(UAE)and vaginal operation were studied as the control groups.The clinical efficacy of the therapeutic methods were compared and analyzed,and the practice value of the treatment was discussed.Method:We selected 120 CSP patients who were diagnosed and treated in our department from January 2016 to December 2017.All patients were randomly divided into three groups.Group A was treated with HIFU ablation,Group B was treated with UAE+ hysteroscopy,and Group C was treated with vaginal CSP resection and repair.The general data of three groups of cases were recorded and the clinical outcomes between three groups were compared.Observed indicator: 1)The basic data of the three groups of patients,such as the average age,the history of pregnancy,the history of birth and the time of the caesarean section were recorded.Meanwhile,the diameter of the fetal sac and the clinical classification were recorded in three groups of cases.2)The success rate of three groups was recorded,including the success rate of the first remedy and the second operation treatment.Meanwhile,the length of stay,the cost of treatment,and the grade of pain rating were observed in three groups of patients 3)The time of vaginal bleeding,the value of serum beta-HCG to normal time,the incidence of complications and the recovery of menstruation after treatment were recorded of three groups.Data processing and statistical analysis: SPSS 21.0 statistical software was used for data processing and statistical analysis.All measurement data was expressed as X ±S,and the enumeration data was expressed as a percentage(%).Data comparison between the three groups was using the one-way ANOVA and multiple comparisons between groups were using LSD method.Chi square test was used to compare enumeration data between the three groups.The difference was statistically significant when P < 0.05.Result:1.Comparison of the basic data of the three groups: 40 patients were included in the Group A,Group B and Group C respective.There were no significant difference in the average age,the history of pregnancy,the history of birth and the CS time between the two groups(P>0.05).2.Comparison of the three groups with disease: Fetal sac diameter: The Group A was 26.8 ± 5.4mm,the Group B was 28.2 ± 6.1mm and the Group C was 25.7 ± 6.6mm.Clinical classification: In the Group A,there were 20 cases(50.0%)of type I,17 cases(42.5%)of type II,and 3 cases(7.5%)of type III.In the Group B,there were 28 cases(70.0%)of type I,11cases(27.5%)of type II,and 1 cases(2.5%)of type III.In the Group C,there were 17 cases(42.5%)of type I,19cases(47.5%)of type II,and 4 cases(10.0%)of type III.The fetal sac diameter and clinical classification of the three groups were not statistically significant(P>0.05).3.Success rate of treatment: 39 cases of primary treatment in the Group A were successful,accounting for 97.5%,1 case were converted to laparoscopy during the uterine curettage.In the Group B,36 cases(90%)were successful for the first time,and 4 cases were operated on the second time.In the Group C,38cases(95%)were successful for the first time.There was no statistically significant difference between the three groups(P>0.05).4.Comparison of other major treatment related indicators: The length of stay: The average length of stay of Group A and group C were less than Group B,the difference was statistically significant(P<0.05).Cost of treatment: Group A was less than Group B and Group C,Group C was less than that in Group B,the differences were statistically significant(P<0.05).Pain grade score: Group A was less than those in Group B and Group C,Group C was less than Group B,the differences were statistically significant(P<0.05).5.Vaginal bleeding after treatment & the value of serum beta-HCG to normal time & complications: There was no statistically significant difference between the three groups(P>0.05).The postoperative menstruation recovery in the Group A and Group C were better than that in the Group B,the difference was statistically significant(P<0.05).Conclusion:1.Compared with the UAE group and the vaginal operation,the average hospitalization time of the HIFU group was shortest,the cost of treatment was least,and the patient's pain grade score was the lowest(P<0.05).2.The recovery of menstruation in patients with HIFU was better than that in the UAE treatment group(P<0.05).There was no significant difference in the success rate of the three groups,the time of vaginal bleeding after treatment,the level of serum beta-HCG to the normal time and the incidence of complications(P>0.05).3.The high intensity focused ultrasound ablation therapy has important clinical value.