Evaluation Of The Clinical Efficacy Of High-intensity Focused Ultrasound In The Treatment Of Cesarean Scar Pregnancy

Objective:Evaluation of clinical efficacy of high-intensity focused ultrasound and traditional treatments in type ? and type ? cesarean scar pregnancy.Methods:We collected the information of patient who diagnosed with cesarean scar pregnancy from Jan.2016 to Jun.2019 in Shenzhen Maternal and Child Health Hospital affiliated to Southern Medical University.The number of eligible patients is 148.Those patients were divided into three groups by treatments-Group A,Group B and Group C.Group A had 69 patients(the type ? is 32 and type ? is 39)who were treated by combination high-intensity focused ultrasound with dilation and curettage(D&C);the patients of group B who were treated by uterine artery chemoembolization and D&C are 59(the type ? is 7 and type ? is 52);patient who underwent transvaginal/trans-laparoscopic/trans-abdominal CSP lesion resection+uterine scar repair belonged to group C,which had 20 patients(the type ? is 4 and type ? is 16).The perioperative clinical and postoperative follow-up indexes of the three groups of type ? and type ? CSP patients were statistically analyzed.Results1.We analyzed the clinical data to find that the following indexes showed no statistical difference:age,gravidity,number of cesarean delivery and abortion,parity,time of menolipsis,the max diametet of gestational sac,the preoperative level of ?-HCG,time from the last cesarean section and preoperative clinical symptoms.2.The comparison of clinical indexes and follow-up indexes between three groups in type ? CSP2.1 The loss of blood during operation and time and expenditure of hospitalization2.1.1 In terms of the loss of blood during operation,Group C is the most and show statistical difference(P=0.029?0.005)by compared with Group A and B.Meantime,Group B is the least,but no statistical difference is found between Group A and B(P=0.455).2.1.2 In terms of time of hospitalization,Group A is the shortest,which is significant different with Group C in statistic(P=0.003).The second is the Group B.However,there is no statistical difference between Group B and Group A and C(P=0.482?0.194).2.1.3 In terms of expenditure of hospitalization,Group B is extremely higher than Group A and C,and there are significant statistical difference(P=0.005?0.005).At the same time,Group C is lowest.While,the comparison of Group C and A shows no statistical difference(P=0.678).2.2 Postoperative recovery2.2.1 The time of menstruation resume and the time to normal of ?-HCG are not statistical difference(P>0.05).2.2.2 There is statistical difference in the postoperative time of vaginal bleeding(P=0.041).Making a pairwise comparison,we find that the comparison of Group A and B,Group A and C and Group B and C show no statistical difference(P>0.05).2.3 Postoperative abnormal menstruation2.3.1 The incidence of hypomenorrhea shows statistical difference(P=0.007).Group C is the highest,and there is statistical difference by comparing with Group A and B(P=0.002?0.033).Group A is the lowest,but no statistical difference can be found in comparison of Group A and B(P>0.05).2.3.2 No statistical difference can be found in the incidence of menostaxis(P>0.05)2.4 There is no statistical difference in incidence of postoperative complications and successful treatment.3.The comparison of clinical indexes and follow-up indexes between three groups in type I CSP3.1 The loss of blood during operation and time and expenditure of hospitalization3.1.1 In terms of the loss of blood during operation.Group B is the least.Meantime,Group C is the most.Comparison of any two groups show statistical difference(P=0.003?0.035 and 0.000,respectively)3.1.2 In terms of time of hospitalization,Group A is the shortest,and group C is the longest.Comparison of any two groups show statistical difference(P=0.006?0.000 and 0.013,respectively).3.1.3 In terms of expenditure of hospitalization,Group B is extremely higher than Group A and C,and there are significant statistical difference(P=0.000?0.000)At the same time,Group C is lowest.While,the comparison of Group C and A shows no statistical difference(P=1.000)3.2 Postoperative recovery3.2.1 In terms of the time of menstruation resume,three groups show statistical difference(P<0.01).The time of menstruation resume of group B is the shortest,and shows much more statistical difference with group A(P=0.008).At the same time,group C is the longest,but shows no statistical difference with group A and B(P>0.05)3.2.2 There is no statistical difference in the postoperative time of vaginal bleeding and the time to normal of ?-HCG(P>0.05).3.3 Postoperative abnormal menstruation3.3.1 The incidence of hypomenorrhea shows statistical difference(P<0.01).Group B is the highest,and there is statistical difference by comparing with Group A and C.(P=0.001?0.001).While group A and C have no statistical difference(P>0.05).3.3.2 No statistical difference can be found in the incidence of menostaxis(P>0.05).3.4 There are statistical difference in incidence of surgical complications of three groups of type ? CSP patients(P=0.018).The incidence of surgical complication of surgical complication is the highest in group C,and the lowest in group A.The results of pairwise complication show that there are no significant statistical differences between any two groups(P<0.0167).Conclusion:1.HIFU is a novel therapeutic means for CSP.It can reduce the risking of bleeding during operation by thermal effect which can block the blood to placenta and gestational sac.Compared with other two treatments,HIFU is a safe and effective therapeutic means with non-invasion and non-radiation for type ? and ?,especially for patient with bearing desire.Its incidence of hypomenorrhea is lower,and its hospital time is shorter.2.For organizations without the equipment of HIFU,the treatment of combination UACE with D&C is an alternative option.The loss of blood in operation and complication is less,but the incidence of hypomenorrhea is higher.3.The treatment of removal of the CSP tissue with scar repair of the uterus has some disadvantage,such as big traumas,heavy bleeding and long time for recovery after operation.Clinically,the prior choice is HIFU and UACE for type I and type II CSP according to doctor's suggestion,but surgical removal of the CSP tissue is also pivotal,which is an essential remedy for complications with other therapeutic means.