不同术式对剖宫产瘢痕部位妊娠疗效及预后的影响OA北大核心CSTPCD

Objective:To explore the effects of different surgical methods on the treatment outcomes and prog-nosis in patients with caesarean section scar pregnancy(CSP).Methods:A total of 90 patients with type n or ⅢCSP admitted to Department of Obstetrics and Gynecology,Affiliated Hospital of Jinggangshan University be-tween February 1,2021 and February 1,2022 were selected as the study subjects.They were enrolled in order of inclusion,exclusion criteria,and admission treatment time.According to different treatment methods,they were di-vided into group A(30 cases),group B(30 cases)and group C(30 cases).The group A underwent laparoscopic uterine artery ligation(UAL)+focus excision and repair of scar pregnancy(FER)+uterine cicatricial repair(UCR),group B underwent uterine artery embolization(UAE)+hysteroscopic FER under ultrasonic monitoring,and group C underwent laparoscopic FER+UCR.The intraoperative and postoperative conditions,as well as the incidence of recurrent CSP(RCSP)rate and repregnancy rate during follow-up in the three groups were com-pared.Results:① The intraoperative blood loss,postoperative uterine drainage volume and postoperative VAS score in groups A and B were lower than those in group C,while the operation time and hospitalization cost were higher than those in group C(P＜0.05).The operation time and hospitalization cost in group A were lower than those in group B(P＜0.05).②The postoperative vaginal hemostasis time,menstrual recovery time and recovery time of serum β-human chorionic gonadotropin(β-HCG)in groups A and B were shorter than those in group C(P＜0.05).③There was no statistically significant difference in the incidence of postoperative complications such as adhesion,infection,severe bleeding,and lower abdominal pain among the three groups(P＞0.05).④The mean follow-up time after surgery was(17.60±5.61)months,and the incidence of RCSP in group A and group C was lower than that in group B(P＜0.05).The rate of repregnancy in group A,group B and group C was 82.14％(23/28),77.78％(21/27)and 81.48％(22/27),respectively,and there was no significant difference in the rate of repregnancy among the three groups(P＞0.05).Conclusions:Laparoscopic UAL+FER+UCR and UAE+ultrasound monitoring hysteroscopic FER can reduce intraoperative bleeding and promote postoperative re-covery,but the surgery time is prolonged and hospitalization costs are higher;After using UCR treatment,the inci-dence of RCSP is lower.Clinical evaluation should be based on the specific condition,economic conditions,and need to preserve fertility of type Ⅱ and Ⅲ CSP patients,and personalized treatment plans should be developed.