Study on the application of reversible uterine artery ligation in type Ⅱ and Ⅲ cesarean scar pregnancy
Objective To investigate the feasibility and safety of laparoscopic reversible uterine artery ligation for type Ⅱ or Ⅲcesarean scar pregnancy(CSP).Methods A retrospective analysis was performed for the type Ⅱ or Ⅲ cesarean scar pregnancy cases treated with surgery at Ningbo Women and Children's Hospital from January 2020 to December 2022,and 28 cases of type Ⅱ or Ⅲcesarean scar undergoing intraoperative laparoscopic surgery and reversible uterine artery ligation were selected as the study subjects.During the operation,laparoscopic reversible uterine artery ligation was performed first,followed by scar removal of the scarred pregnancy,excision and repair of scar tissue.The operation time,intraoperative blood loss,complications and other perioperative conditions,as well as the decrease in serum human chorionic gonadotropin(β-hCG)24 hours after operation and the recurrence of pregnancy in patients with type Ⅱ and type Ⅲ were analyzed and compared.Results In this study,the average age of CSP patients was 35.03±5.51 years,the average duration of menstruation was 4.48±15.34 days,and the average serum β-hCG level before treatment was 114 148.69±80 957.08 mIU/mL.There were 19 cases of type Ⅱ and 9 cases of type Ⅲ.There was no significant difference in general clinical data between the two groups(P＞0.05).The Among the 28 patients,27 patients successfully completed the operation,with an average intraoperative blood loss was 174.19±145.48 mL,the operation time was 136.30±39.56 min,and the serum β-hCG decreased by 62.44±14.80％24 hours after the operation.In one patient,despite uterine artery ligation,there was continuous heavy vaginal bleeding during hysteroscopic removal of the pregnancy product,and the bleeding stopped after balloon tamponade,with a total bleeding of 1 200 mL.None of the patients had serious complications such as bladder injury.There was a statistically significant difference in the intraoperative blood loss and operation time of type Ⅲ CSP patients compared with type Ⅱ patients(t=2.243,3.381,P＜0.05),but there was no significant difference in other surgical indexes(P＞0.05).After an average follow-up of 26.71±9.28 months,two of the eight patients with reproductive intention were pregnant again,including one patient with full-term cesarean section and one patient had a recurrent pregnancy in the uterine scar again.Conclusion Laparoscopic reversible uterine artery ligation is safe and effective for type Ⅱ or Ⅲ cesarean scar pregnancy and can be used as an alternative to uterine artery embolization.However,it should be cautious for patients with high β-hCG level,large mass,positive fetal heartbeat,and placenta accreta on imaging.
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