Clinical analysis on selective uterine artery embolization combined with hysteroscopic surgery for ;exogenous cesarean scar pregnancy in 67 cases
10.3760/cma.j.issn.0529-567x.2015.08.003
- VernacularTitle:选择性子宫动脉栓塞术联合宫腔镜手术治疗外生型剖宫产术后子宫瘢痕妊娠67例临床分析
- Author:
Guangwei WANG
;
Xiaofei LIU
;
Dandan WANG
;
Qing YANG
- Publication Type:Journal Article
- Keywords:
Pregnancy,ectopic;
Cesarean section;
Hysteroscopy;
Uterine artery embolization
- From:
Chinese Journal of Obstetrics and Gynecology
2015;(8):576-581
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the safety and feasibility of uterine arterial embolization (UAE) combined with hystersocpic excisionl of exogenous cesarean scar pregnancy (CSP). Methods Totally 67 patients with exogenous CSP treated with selective UAE combined with hysterscopic surgery in Shengjing Hospital of China Medical University were analyzed retrospectively; 35 patients in Group A (thickness of the cesarean scar>3 mm), while 32 patients in Group B (thickness of the cesarean scar≤3 mm). The following clinical parameters including operative time, intraoperative blood loss, quantity of postoperative uterine drainage, postoperative hospital days, the time for the mass absorption and the return ofβ-hCG to normal were compared. Results All hysterscopic procedures were successfully completed in Group A, and only one case underwent a second hysteroscopic excision due to the 1-month postoperative ultrasound examination indicating a mass located in the cesarean scar and a slow decline of β-hCG. Three cases of Group B were transformed to laparoscopic or laparotomy operation and 7 cases underwent a second surgery. The volume of introperative blood loss was (97±41) ml in Group A and (161±92) ml in Group B, the difference was statistically significant (P<0.01). But the operative time, quantity of postoperative uterine drainage, postoperative hospital days, the time for the retrun ofβ-hCG to normal and the mass absorption in Group A were (36±9) minutes, (38±13) ml, (3.5±0.5) days, (26±5) days, (82±17) days, in Group B were (37± 9) minutes, (42 ± 16) ml, (4.0 ± 0.7) days, (28 ± 8) days, (88 ± 15) days, respectively, the differences were not statistically significant (all P>0.05). Conclusions For exogenous CSP, when the thickness of cesarean scar is ≤3 mm, whether or not undertaking UAE, it should be seen as contraindication of hysterscopic surgery. UAE combined with hysterscopic surgery for the treatment of exogeous CSP with the cesarean scar thickness>3 mm is safe and feasible according to patients condition and should be performed by experienced hysteroscopist.
