【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.
【关键词】
《建筑知识》 2015-05-12
《中国医疗管理科学》 2015-05-12
《中国医疗管理科学》 2015-05-12
《中国医疗管理科学》 2015-05-12
《重庆高教研究》 2015-06-25
《铁道运营技术》 2015-07-06
《中外医疗》 2015-07-03
《重庆高教研究》 2015-06-29
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