To Explore The Indicators That Can Predict The Outcome Of Hysteroscopic Surgery In The Treatment Of Cesarean Scar Pregnancy

Objective: To explore the indicators that can predict the outcome of hysteroscopic surgery in the treatment of cesarean scar pregnancy(CSP)Methods: 101 patients diagnosed with cesarean scar pregnancy in our hospital from December 2012 to December 2018 were divided into two groups according to the surgical outcomes.The successful group is defined as the control group,and the surgical failure group is defined as the experimental group.the failure group(Patients who had changed treatment strategies during hysteroscopy and those who needed reoperation,n=58),the Success group(n = 43).Results: Univariate analysis showed that there were no significant differences in age,time from the previous cesarean section,number of cesarean section,preoperative HCG level,preoperative vaginal bleeding,gestational sac fetal heart and scar thickness between the experimental group and the control group.Risk factors for surgical failure included longer menopause,larger gestational sac or mass,abundant blood flow,mass CSP and larger cesarean scar diverticulum(CSD)area,deeper CSD depth,longer CSD entrance length and more protrusion of scar diverticulum(P < 0.05).Multivariate logistic regression analysis showed that the regression model had statistical significance(2= 46.293,P < 0.05).The only significant variable in the model was the size of cesarean scar diverticulum(P = 0.023).The area under ROC curve(AUC)of logistic model was 0.906,95% CI was 0.840-0.973,and the cut-off value was P=0.42,sensitivity was 90.9%,specificity was 77.1%,and the size of CSD corresponding to the cut-off value was about 40 mm.Conclusion: This study found that the size of CSD may affect the outcome of hysteroscopic surgery in CSP patients,which provides a quantitative index for preoperative risk assessment system of CSP.At the same time,the best predictive value of the size of CSD was obtained,which is of guiding significance for the selection of hysteroscopic surgery.