| Objective:By comparing the therapeutic effects of different surgical methods in type Ⅱ and Ⅲ cesarean scar pregnancy(Cesarean Scar Pregnancy,CSP),to explore the best surgical methods for type Ⅱ and Ⅲ CSP.Methods:The subjects of the study were patients with type Ⅱ and Ⅲ CSP who were treated in the Department of Gynecology of the First People’s Hospital of Qujing City from January 2018 to October 2020.According to different treatment methods,the patients were divided into three groups:X,Y,and Z.The treatment of patients in group X was medication(mifepristone+misoprostol)+ultrasound-guided evacuation,and patients in group Y were treated by Uteine Artery Embolization(UAE)+ultrasound-guided evacuation,Z The treatment of patients in the group was scar pregnancy lesion resection+uterine repair.Collect the patient’s age,menopausal days,preoperative blood β-hCG value,gestational sac diameter,number of cesarean sections,time from this pregnancy to last cesarean section;patient intraoperative blood loss,blood β-hCG level 3 days after surgery,Surgical complications,hospitalization days,hospitalization expenses;investigate whether the patient’s bloodβ-hCG returns to normal 2 months after surgery.Results:(1)There was no significant difference in basic preoperative information(age,menopausal days,diameter of gestational sac,number of cesarean sections,time between this pregnancy and last cesarean section)of the three groups of patients(p>0.05);the preoperative blood β-hCG comparison,the difference was statistically significant(p<0.05).The preoperative blood β-hCG of group X was lower than that of group Y(p<0.05).There was no significant difference between group X and group Z(p>0.05).There was no significant difference between group Y and group Z(p>0.05).(2)There was no statistically significant difference in intraoperative blood loss between the three groups(p>0.05);there was a statistically significant difference in the blood β-hCG reduction rate of the three groups of patients at 3 days postoperatively(p<0.05),specifically after the X group The 3-day β-hCG decline rate was lower than that of the Y group(p=0.003),the β-hCG decline rate 3 days after the X group was less than that of the Z group(p=0.011),the β-hCG decline rate 3 days after the Y group and the Z group There was no statistically significant difference in comparison(p>0.05);compared with the number of days of hospitalization of the three groups of patients,the difference was statistically significant(p<0.05),specifically the hospitalization time of group X was shorter than that of group Y and group Z(p<0.05)),there was no significant difference in the number of days of hospitalization between group Y and group Z(p>0.05).The hospitalization expenses of the three groups were compared,and the difference was statistically significant(p<0.05).Specifically,the hospitalization expenses of patients in group X were lower than those in group Y(p<0.001),and the hospital expenses in group X were lower than those in group Z(p<0.001).There was no statistically significant difference in hospitalization expenses between group Y and group Z(p>0.05)(3)Comparing the surgical success rate of the three groups of patients,the success rate of patients in group X was 70%,and the success rates of patients in group Y and C were both 87.5%,and the difference was not statistically significant(p>0.05).(4)Investigate whether the blood β-hCG of the patients returned to normal within 2 months after the operation.The proportion of the X group returning to normal was 75%,the proportion of returning to normal in the Y group was 100%,and the proportion of returning to normal in the Z group was 95.83%.There was no difference.Statistical significance(p>0.05).Conclusions:(1)The three methods of ultrasound-guided uterine evacuation,UAE+uterine evacuation,and CSP lesion resection+uterine repair have their own advantages and disadvantages for the treatment of type Ⅱ and Ⅲ CSP.The doctor should make the most appropriate treatment plan according to the individual;(2)Ultrasound-guided uterine evacuation has more bleeding during surgery and is prone to complications.However,this treatment method has a short hospital stay and low hospitalization costs.Make preparations for emergency surgery during uterine evacuation;(3)UAE+ultrasound guided evacuation has less blood loss and fewer postoperative complications,but the patient ’s hospitalization costs are the highest,the length of stay is the longest,and the cooperation of multiple departments is required,which cannot be widely promoted in primary hospitals;(4)CSP lesion resection+uterine scar repair includes laparoscopy,laparotomy,and transvaginal surgery.The intraoperative bleeding is slightly more than UAE,but the hospitalization time is short,the hospitalization cost is low,and the uterine scar can be repaired.For Ⅱ,Type Ⅲ CSP patients is a better treatment method,especially transvaginal surgery is a minimally invasive surgery,and has low requirements for physicians and equipment,and can be widely promoted. |
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