Clinical analysis of uterine artery embolization combined with laparoscopy in the treatment of exogenous cesarean scar pregnancy
Objective To investigate the clinical feasibility and safety of laparoscopic management combined with uterine ar-tery embolization(UAE)for the treatment of exogenous cesarean scar pregnancy(CSP).Methods A retrospective analy-sis was conducted on clinical data of 65 patients with exogenous CSP who underwent UAE combined with laparoscopic treatment at the Seventh Medical Center of PLA General Hospital from January 1,2012,to December 31,2019.Patients were divided into two groups based on the laparoscopic surgical approach:lesion excision group(n=38)and laparoscopic surveillance-guided curettage group(n=27).Surgical blood loss,treatment outcomes,complications,and postoperative recovery were compared between the two groups.Results All patients underwent bilateral uterine artery embolization successfully in one attempt,and the procedure proceeded smoothly.There was no need for blood transfusion in either group.The mean surgical blood loss was(103.521±30.814)ml in the lesion excision group and(87.424±58.525)ml in the curettage group,with no statistically significant difference(t=1.056,P=0.302).The effective rate of treatment was 100.0％(38/38)in the lesion excision group,higher than that 59.3％(16/27)in the curettage group,with a statisti-cally significant difference(x2=15.760,P=0.005).No intraoperative or postoperative complications occurred in either group.Blood β-human chorionic gonadotropin(β-HCG)levels declined normally 2-6 weeks postoperatively,and men-struation resumed normally 5-8 weeks postoperatively.The rate of subsequent pregnancy within 5 years postoperatively was 52.0％(13/25).Further stratification of patients in the laparoscopic surveillance-guided curettage group showed that among patients treated within 8 weeks of gestation with scar thickness ≥2 mm,14 out of 17 cases were successfully treated with curettage,while 3 cases required additional surgery due to residual tissue.Conversely,among patients trea-ted after 8 weeks of gestation with scar thickness＜2 mm,only 2 out of 10 cases were successfully treated,showing a statistically significant difference in treatment efficacy,x2=10.145,P=0.023.Conclusions UAE pretreatment can con-trol bleeding accurately,and combined with laparoscopy can be used in the treatment of exogenous CSP safely and effec-tively.Early diagnosis and treatment are recommended.For exogenous CSP with muscular thickness ≥2 mm within 8 weeks of pregnancy,close monitoring curettage under laparoscopy can be considered.
NETL
NSTL
万方数据
