Efficacy and safety of different preconditioning methods combined with dilatation & curettage under ultrasonic monitoring in the treatment of exogenous cesarean scar pregnancy

doi:10.3877/cma.j.issn.2095-5782.2021.04.004

Abstract

Abstract:

Objective

To investigate the efficacy and safety of different preconditioning methods combined with dilatation & curettage under ultrasonic monitoring in the treatment of exogenous cesarean scar pregnancy (CSP).

Methods

A retrospective analysis was performed on 76 patients with exophytic CSP, of whom 40 (MTX group) were treated with gestational sac aspiration + methotrexate (MTX) intracapsular injection + mifepristone oral administration + D&C under ultrasonic monitoring, and36 (UAE group) were treated with MTX perfusion + uterine artery embolization (UAE) + mifepristone oral administration + D&C under ultrasonic monitoring.Clinical cure rate, intraoperative blood loss, conversion to laparotomy ratio, β-human chorionic gonadotropin( β-HCG) recovery time, postoperative vaginal bleeding time, hospital stay days, hospital cost, menstrual recovery time, tubal patency rate 3 months after the operation, repregnancy rate 2 years after the operation, CSP recurrence rate 3 years after the operation, postoperative adverse reactions and complications were compared between the two groups.

Results

The clinical cure rate, β-HCG recovery time, hospitalization cost of UAE group were higher than those of MTX group (P < 0.05), while the intraoperative blood loss, conversion rate to laparotomy, vaginal bleeding time and hospitalization days were lower than those of MTX group (P < 0.05). The menstrual recovery time of UAE group was longer than that of MTX group (P < 0.05). There were no statistically significant differences between the two groups in rate of fallopian tube patency 3 months after surgery, rate of repregnancy 2 years after surgery, and rate of CSP recurrence 3 years after surgery (P > 0.05). Fever, leukocyte decline, lower abdominal pain, nausea and vomiting after surgery were not significantly different between the two groups (P > 0.05).

Conclusions

MTX perfusion + UAE + mifepristone oral administration + D&C under ultrasonic monitoring is more effective in the treatment of exophytic CSP, and has no significant bad influence on long-term fertility.

Key words: Cesarean scar pregnancy, Exophytic type, Uterine artery embolization, Methotrexate, Mifepristone

Jianshuang Wang, Haijing Zhang, Xuesong Wang, Ying Wen, Zijing Zhou. Efficacy and safety of different preconditioning methods combined with dilatation & curettage under ultrasonic monitoring in the treatment of exogenous cesarean scar pregnancy[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2021, 09(04): 371-375.

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References 28

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组别	n	年龄（岁）	BMI（kg/m²）	距末次剖宫产时间（年）	停经时间（d）	瘢痕处子宫肌层厚度（mm）	病灶直径（cm）	血β-HCG水平（IU/L）
MTX组	40	30.36 ± 5.49	23.67 ± 2.83	3.67 ± 2.65	53.07 ± 12.45	3.49 ± 1.60	3.27 ± 0.87	21 986 ± 1 670
UAE组	36	29.89 ± 6.02	23.91 ± 2.77	4.09 ± 3.18	52.78 ± 10.93	3.71 ± 1.58	3.50 ± 0.65	22 391 ± 1 719

组别	n	年龄（岁）	BMI（kg/m²）	距末次剖宫产时间（年）	停经时间（d）	瘢痕处子宫肌层厚度（mm）	病灶直径（cm）	血β-HCG水平（IU/L）
MTX组	40	30.36 ± 5.49	23.67 ± 2.83	3.67 ± 2.65	53.07 ± 12.45	3.49 ± 1.60	3.27 ± 0.87	21 986 ± 1 670
UAE组	36	29.89 ± 6.02	23.91 ± 2.77	4.09 ± 3.18	52.78 ± 10.93	3.71 ± 1.58	3.50 ± 0.65	22 391 ± 1 719

组别	n	预处理治疗的临床治愈率[%（n）]	术中出血量（mL）	中转开腹手术率[%（n）]	β-HCG恢复时间（d）	阴道流血时间（d）	住院日数（ｄ）	住院费用（元）
MTX组	40	77.5（31）	126.3 ± 11.8	7.5（3）	28.5 ± 3.6	14.0 ± 4.3	16.7 ± 4.1	7 130.9 ± 1 035.4
UAE组	36	91.7（33）^a	83.7 ± 6.9^a	0（0）^a	33.2 ± 2.9^a	6.5 ± 2.7^a	7.8 ± 2.0^a	14 903.6 ± 1 683.7^a

组别	n	预处理治疗的临床治愈率[%（n）]	术中出血量（mL）	中转开腹手术率[%（n）]	β-HCG恢复时间（d）	阴道流血时间（d）	住院日数（ｄ）	住院费用（元）
MTX组	40	77.5（31）	126.3 ± 11.8	7.5（3）	28.5 ± 3.6	14.0 ± 4.3	16.7 ± 4.1	7 130.9 ± 1 035.4
UAE组	36	91.7（33）^a	83.7 ± 6.9^a	0（0）^a	33.2 ± 2.9^a	6.5 ± 2.7^a	7.8 ± 2.0^a	14 903.6 ± 1 683.7^a

组别	n	月经恢复时间	术后3个月输卵管通畅率			术后2年再妊娠率	术后3年CSP复发率
组别	n	月经恢复时间	通畅	通而不畅	阻塞	术后2年再妊娠率	术后3年CSP复发率
MTX组	40	32.49 ± 4.63	70.0（28）	22.5（9）	7.5（3）	30.0（12）	7.5（3）
UAE组	36	37.81 ± 5.08^a	63.9（23）	25.0（9）	11.1（4）	25.0（9）	2.8（1）

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