| Objective:Retrospective analysis of the clinical outcome of uterine artery embolization(UAE)combined with dilatation and Curettage(D&C)in 139 caesarean scar pregnancy(CSP)patients with cesarean section scar site after cesarean section in our hospital.The postoperative recovery of patients of different age groups and the clinical analysis of three months after operation were compared.And in a variety of factors(the number of induced abortion,the number of cesarean section,the interval from the last cesarean section,gestational weeks and classification)under the influence of the next three years of pregnancy analysis.Methods:1.From February 2014 to December 2015,139 patients who had the intention to get pregnant again.received(CSP)via uterine artery embolization(UAE)combined with dilatation and Curettage(D&C)were collected from the first affiliated Hospital of Kunming Medical University the data were analyzed retrospectively.According to age,the patients were divided into<35 years old group(68 cases)and?35 years old group(71 cases).Analysis of short-term curative effect after operation between the two groups(such as the time of resuming menstruation and the time when ?-hCG returned to normal)and analysis of long-term endocrine effects of two groups of patients before and 3 months after operation(such as menstrual volume,menstrual cycle and menstrual period).Combined with the retrospective analysis of pregnancy situation and pregnancy outcome under the influence of multiple factors(induced abortion,cesarean section,interval from the last cesarean section,gestational weeks and classification),in order to provide a basis for clinical treatment of CSP.2.The statistical analysis was carried out by SPSS21.0 statistical software,the measurement data were expressed as mean ± standard deviation(x±s),t test,Chi square test(x 2)were used for analysis,and logistics regression was used for multi-factor analysis.Results:1.The recovery time of menstruation was(40.9±14.4)days in the group of<35 years old and(43.2±16.6)days in the group of age?35 years old(P>0.05).2.The recovery time of ?-hCG to normal in patients with CSP<35 years old was(29.7±4.9)days,and that in patients with age?35 years old was(29.8±4.8)days,P>0.05?3.The menstrual volume of 68 patients with CSP aged<35 years decreased before and 3 months after operation(74.26±13.42),P<0.05),the menstrual period was(6.34±1.016)days before operation and(5.26±0.89)days 3 months after operation(P<0.05).The menstrual cycle was(29.1±3.0)before operation and(31.1±4.8)months after operation(P<0.05).4.The age of patients with CSP?35 years old was compared with that of 3 months after operation.After operation,the menstrual volume decreased to(68.5±16.18),P<0.05),and the menstrual period was(6.11±1.103)days before operation and(5.14±0.82)days after 3 months,P<0.05,P<0.05;In this group,the menstrual cycle was(29.1±4.4)days before operation and(32.9±5.4)days months after operation(P<0.05).5.People under the age of 35 there were 56 cases of pregnancy(82.35%),12 cases of non-pregnancy(17.64%),52 cases of pregnancy(73.23%)and 19 cases of non-pregnancy(26.76%).The pregnancy was compared between the two groups(P>0.05).6.Previous artificial abortion 0 times there were 28 cases of pregnancy(73.68%)and 10 cases of non-pregnancy(26.31%);previous artificial abortion 1 times there were 45 cases of pregnancy(81.81%)and 10 cases of non-pregnancy(18.18%);previous artificial abortion 2 times there were 22 cases of pregnancy(68.75%)and10 cases of non-pregnancy(31.25%);previous artificial abortion 3 times there were 13 cases of pregnancy(92.85%)and 1 case of non-pregnancy(7.14%).The number of induced abortion was compared with that of pregnancy(P>0.05).7.Previous cesarean section 1 times there were 59 cases of pregnancy(71.95%)and 23 cases of non-pregnancy(28.05%),previous cesarean section 2 times 49 cases of pregnancy(85.96%)and 8 cases of non-pregnancy(14.03%).The pregnancy status was compared between the two groups(P>0.05).8.Patients with an interval of less than 2 years from the last cesarean section there were 39 cases of pregnancy(60.93%),25 cases of non-pregnancy(39.06%),;patients with an interval of more than 2 years from the last cesarean section 69 cases of pregnancy(92.00%)and 6 cases of non-pregnancy(8.00%).There was significant difference in pregnancy between the two groups(P<0.05).9.The gestational age was less than 8 weeks at the time of treatment there were 79 cases of pregnancy(90.80%),8 cases of non-pregnancy(9.20%);gestational weeks?8 weeks at the time of treatment29 cases of pregnancy(55.77%)and 23 cases of non-pregnancy(44.23%).There was significant difference between the two groups(P<0.05).10.Under endomorphism there were 87 cases of pregnancy(90.63%),9 cases of non-pregnancy(9.38%);exogenous person 21 cases of pregnancy(48.84%)and 22 cases of non-pregnancy(51.16%).There was significant difference between the two groups(P<0.05).11.Treatment of CSP patients with UAE combined with dilatation and curettage within three years there were 108 cases of pregnancy(77.70%),including 69 cases of normal third trimester pregnancy(49.64%),17 cases of spontaneous abortion(12.23%)and 20 cases of induced abortion(14.39%),among which 69 cases(49.64%)were normal late pregnancy,17 cases(12.23%)were spontaneous abortion and 20 cases(14.39%)were induced abortion.There were 2 cases of pregnancy(RCSP)(1.44%)and 31 cases of non-pregnancy(22.30%)in recurrent cesarean section.Conclusion:1.After UAE combined with hysterectomy,age has little effect on postoperative recovery in patients with CSP.2.After UAE combined with hysterectomy,menstrual volume decreased,menstrual period shortened and menstrual cycle prolonged in patients with CSP of any age.this result may be related to ovarian function and endometrial injury after operation.3.After UAE combined with hysterectomy,the age,the number of previous induced abortion and the number of cesarean section had little effect on the second pregnancy in CSP patients.4.After UAE combined with hysterectomy,the longer the interval from the last cesarean section,the smaller the gestational weeks and the higher the rate of endotype repregnancy in CSP patients.5.The overall pregnancy outcome of CSP patients after UAE combined with hysterectomy was good. |
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