Liu Ting, Xu Xiaoqin
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.
J Obstet Gynaecol. 2022 Oct;42(7):3041-3047. doi: 10.1080/01443615.2022.2081793. Epub 2022 Jun 7.
To compare the efficacies between ultrasound-guided curettage combined with hysteroscopic electro-resection after injection of pituitrin and hysteroscopic electro-resection after methotrexate chemotherapy in the treatment of caesarean scar pregnancy (CSP). 60 patients with CSP admitted to our hospital were selected as the study subjects, and divided into observation group ( 35) and control group ( = 25) in accordance with the therapeutic options. The observation group was treated with ultrasound-guided curettage combined with hysteroscopic electro-resection after injection of pituitrin, while the control group was treated with hysteroscopic electro-resection after methotrexate chemotherapy. The observation group was superior to the control group in the amount of intraoperative haemorrhage, in-hospital costs, and postoperative time to control vaginal haemorrhage, time to return to a normal serum human chorionic gonadotropin (HCG) level. The observation group had a lower incidence rate of adverse reactions (5.71% vs. 28.00%, < .05) and a higher first-attempt success rate for treatment (85.71% vs. 84.00%, > .05) compared with the control group. Ultrasound-guided curettage combined with hysteroscopic electro-resection after injection of pituitrin, exhibiting a higher efficacy, can more effectively shorten the postoperative recovery, reduce adverse reactions, and improve the postoperative quality of life in patients with CSP. IMPACT STATEMENT Caesarean scar pregnancy (CSP), a rare form of ectopic pregnancy where the fertilised egg is implanted in the muscle or fibrous tissue of the scar after a previous caesarean section (CS), is a long-term complication of CS that may be life-threatening for parturients. Some therapies have been used to treat CSP, such as uterine artery embolisation and uterine artery embolisation chemotherapy combined with curettage, but the potential adverse effects may affect the ovarian reserve and even affecting the fertility of patients. This study showed that ultrasound-guided curettage combined with hysteroscopic electro-resection after injection of pituitrin, exhibiting a higher efficacy, can more effectively shorten the postoperative recovery, reduce adverse reactions, and improve the postoperative quality of life in patients with CSP. The findings of this study may provide some references for the clinical practitioners and further research and may contribute to the treatment of CSP.
比较垂体后叶素注射后超声引导下刮宫联合宫腔镜电切术与甲氨蝶呤化疗后宫腔镜电切术治疗剖宫产瘢痕妊娠（CSP）的疗效。选取我院收治的60例CSP患者作为研究对象，根据治疗方案分为观察组（35例）和对照组（25例）。观察组采用垂体后叶素注射后超声引导下刮宫联合宫腔镜电切术治疗，对照组采用甲氨蝶呤化疗后宫腔镜电切术治疗。观察组在术中出血量、住院费用、术后阴道出血控制时间、血清人绒毛膜促性腺激素（HCG）水平恢复正常时间方面均优于对照组。与对照组相比，观察组不良反应发生率较低（5.71% vs. 28.00%，P<0.05），首次治疗成功率较高（85.71% vs. 84.00%，P>0.05）。垂体后叶素注射后超声引导下刮宫联合宫腔镜电切术疗效较高，能更有效地缩短术后恢复时间，减少不良反应，提高CSP患者术后生活质量。影响声明剖宫产瘢痕妊娠（CSP）是一种罕见的异位妊娠形式，受精卵在前次剖宫产（CS）后植入瘢痕的肌肉或纤维组织中，是CS的一种长期并发症，对产妇可能有生命危险。一些疗法已被用于治疗CSP，如子宫动脉栓塞术和子宫动脉栓塞化疗联合刮宫术，但潜在的不良反应可能影响卵巢储备，甚至影响患者的生育能力。本研究表明，垂体后叶素注射后超声引导下刮宫联合宫腔镜电切术疗效较高，能更有效地缩短术后恢复时间，减少不良反应，提高CSP患者术后生活质量。本研究结果可为临床医生和进一步研究提供一些参考，可能有助于CSP的治疗。
