Comparison of the Efficacy and Safety of Different Surgical Strategies for Patients with Type II Cesarean Scar Pregnancy

• 作者: Chang Kai-Kai Cheng Qi Tian Qi Yi Xiao-Fang
• 来源期刊: 生殖与发育医学（英文）
• 关键词: Dilatation and Curettage Ectopic Pregnancy Laparoscopy Assisted by Operative Hysteroscopy Uterine artery Embolization
• 年，卷（期）: 2020,（2）
• 所属期刊栏目: Original Article
• 页码范围: 89-96
• 页数: 8页
• 语种: 中文
• DOI: 10.4103/2096-2924.288024

摘要

Objective::To compare the efficacy and safety of four surgical strategies currently used for the management of deep implantation cesarean scar pregnancy (CSP-II).Methods::This was a retrospective clinical cohort study, and, in total, 131 women diagnosed with CSP-II and primarily treated in our hospital were recruited. Women treated using laparoscopy assisted by operative hysteroscopy (LAOH; Group A, n = 25), uterine artery embolization (UAE) followed by LAOH (Group B, n = 21), ultrasound-guided dilatation and curettage (D&C; Group C, n = 24), and UAE followed by D&C (Group D, n = 61) were evaluated. Univariate and multiple logistic analyses were performed to identify the risk factors. Results::No statistically significant difference was found in patient age, gestational age, size of lesion, and pretreatment serum β-human chorionic gonadotropins (β-hCG) level. Operation time was longer ( P < 0.001) and the success rate was higher ( P = 0.01) in both Group A and Group B than in Group C and Group D. When the cohort was further analyzed regarding patients with myometrial thickness ≤3 mm ( n = 75, defined as CSP-IIb), a lower rate of perioperative complications ( P = 0.036) and a higher success rate ( P < 0.001) remained in Group A ( n = 15) and Group B ( n = 15) but not in Group C ( n = 11) or Group D ( n = 34). In multiple logistic regression analysis, the risk factors related to lower treatment efficacy for patients with CSP-II were thinner myometrial thickness of cesarean scar (CS) (≤3 mm) (odds ratio [ OR] = 5.470, P = 0.062), number of cesarean sections (a2) ( OR = 8.877, P = 0.013), mass protruding into the bladder or abdominal cavity ( OR = 25.507, P < 0.001), and direct D&C modality ( OR = 38.247, P = 0.010). Conclusions::Compared with D&C ± UAE, LAOH ± UAE showed a higher success rate for patients with CSP-II, especially when the zygote was more deeply implanted with a myometrial thickness of CS ≤ 3 mm. CSP-II treatment should be individualized on the basis of many risk factors.

作者信息

序号	姓名	单位	发文数	被引次数	H指数	G指数
1	Cheng Qi		1	0	0.0	0.0
2	Tian Qi		1	0	0.0	0.0
3	Chang Kai-Kai		1	0	0.0	0.0
4	Yi Xiao-Fang		1	0	0.0	0.0