Feng Minqing, Shang Huiling, Chen Xiangdong, Chen Jiebo, Cui Yunneng, Wang Hao, Ou Yuyi, Huang Xiaobin
Department of Gynecology, Foshan Women and Children Hospital Affiliated to Guangdong Medical University, Foshan, Guangdong Province, 528000, People's Republic of China.
Department of Radiology, Foshan Women and Children Hospital Affiliated to Guangdong Medical University, Foshan, Guangdong Province, 528000, People's Republic of China.
Int J Womens Health. 2025 Aug 27;17:2685-2697. doi: 10.2147/IJWH.S536488. eCollection 2025.
Cesarean scar pregnancy (CSP) is an uncommon and potentially life-threatening form of ectopic pregnancy characterized by embryo implantation within the scar tissue of a prior cesarean delivery.
The aim of this study is to compare clinical outcomes between focused ultrasound ablation surgery (FUAS) combined with suction curettage under hysteroscopic guidance and transvaginal debridement and repair surgery (TDRS) in the treatment of CSP.
A retrospective analysis was conducted on 78 patients with CSP and treated between 2017 and 2023. Among them, 25 received FUAS followed by hysteroscopic suction curettage, and 53 underwent TDRS. Key clinical indicators included intraoperative parameters, postoperative recovery, treatment costs, complications, and subsequent pregnancy outcomes.
No significant differences were observed between the two groups in terms of intraoperative blood loss, decline rates of β-human chorionic gonadotropin and hemoglobin, or menstrual recovery. FUAS was associated with a significantly shorter operative time (34.96 ± 28.90 vs 60.13 ± 22.87 minutes, <0.001), but also with a longer hospital stay (7.92 ± 2.98 vs 5.38 ± 1.61 days, < 0.001) and higher treatment costs (Ren Min Bi (RMB) 15,278 ± 3980 vs RMB 9443 ± 1570, <0.001). The treatment success rate was 76.00% for FUAS and 96.23% for TDRS (=0.078). Among patients seeking fertility, post-treatment pregnancy rates were 71.43% in the FUAS group and 76.47% in the TDRS group ( > 0.05). No procedure-related complications were reported in either group.
Both FUAS combined with curettage and TDRS demonstrated safety and effectiveness in the treatment of CSP, with favorable post-treatment fertility outcomes. TDRS was associated with shorter hospitalization and lower medical costs and may be preferable for certain CSP subtypes, such as type III. Treatment selection should be individualized based on clinical characteristics.
剖宫产瘢痕妊娠（CSP）是一种罕见且可能危及生命的异位妊娠形式，其特征为胚胎植入既往剖宫产的瘢痕组织内。
本研究旨在比较聚焦超声消融手术（FUAS）联合宫腔镜引导下刮宫术与经阴道清创修复手术（TDRS）治疗CSP的临床结局。
对2017年至2023年间治疗的78例CSP患者进行回顾性分析。其中，25例接受FUAS后行宫腔镜刮宫术，53例行TDRS。关键临床指标包括术中参数、术后恢复情况、治疗费用、并发症及后续妊娠结局。
两组在术中出血量、β-人绒毛膜促性腺激素和血红蛋白下降率或月经恢复方面未观察到显著差异。FUAS的手术时间显著更短（34.96 ± 28.90 vs 60.13 ± 22.87分钟，<0.001），但住院时间更长（7.92 ± 2.98 vs 5.38 ± 1.61天，<0.001）且治疗费用更高（人民币15,278 ± 3980 vs人民币9443 ± 1570，<0.001）。FUAS的治疗成功率为76.00%，TDRS为96.23%（P = 0.078）。在有生育需求的患者中，FUAS组治疗后的妊娠率为71.43%，TDRS组为76.47%（P>0.05）。两组均未报告与手术相关的并发症。
FUAS联合刮宫术和TDRS在治疗CSP方面均显示出安全性和有效性，治疗后的生育结局良好。TDRS与较短的住院时间和较低的医疗费用相关，对于某些CSP亚型（如III型）可能更可取。应根据临床特征进行个体化的治疗选择。
