Comparative Analysis of the Efficacy of Four Different Surgical Modalities in the Treatment of Cesarean Scar Pregnancy: A Multicenter Retrospective Study.

IF 3.4 3区医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL Advances in Therapy Pub Date : 2025-01-24 DOI:10.1007/s12325-024-03097-0

Yin Yin, Limei Huang, Nuo Xu, Hua-Gang Ma, Chaoyan Yuan

{"title":"Comparative Analysis of the Efficacy of Four Different Surgical Modalities in the Treatment of Cesarean Scar Pregnancy: A Multicenter Retrospective Study.","authors":"Yin Yin, Limei Huang, Nuo Xu, Hua-Gang Ma, Chaoyan Yuan","doi":"10.1007/s12325-024-03097-0","DOIUrl":null,"url":null,"abstract":"Introduction: This study explored the effects of four different surgical methods in the treatment of cesarean scar pregnancy (CSP).Methods: In this multicenter retrospective analysis of 359 patients, the surgical indices, the time taken for the serum human chorionic gonadotropin level to return to normal, the recovery time of menstruation, and the incidence of postoperative adverse reactions were comparatively analyzed. The clinical efficacies of various preoperative treatment methods to block the blood supply to CSP tissues and those of four different surgical methods to treat CSP, namely, curettage, hysteroscopic surgery, laparoscopic surgery, and vaginal surgery, were evaluated in this study.Results: Hysteroscopic pregnancy tissue removal in patients with type I CSP was found to be associated with low cost, rapid postoperative recovery, and a low incidence of postsurgical complications. Among patients with type II-III CSP, the operation success rate (96.97% for type II and 88.46% for type III) in those who underwent uterine artery embolization + curettage was lower than that in patients from the other groups (all 100%). Among patients with type III CSP who underwent transvaginal ligation of the descending uterine artery + hysteroscopic removal of the pregnancy tissues, three patients (12.5%) underwent hysteroscopic surgery under transumbilical single-port laparoscopic surveillance so as to avoid uterine perforation considering that the pregnancy tissue was only 1 mm away from the uterine plasma membrane layer.Conclusion: Hysteroscopic surgery without pretreatment can be adopted for patients with type I CSP. In contrast, patients with type II and III CSP should be initially pretreated with vascular ligation to prevent intraoperative bleeding, followed by laparoscopic or vaginal surgery.Trial registry: Clinical Trial Registry Number ChiCTR2000040357.","PeriodicalId":7482,"journal":{"name":"Advances in Therapy","volume":" ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Advances in Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12325-024-03097-0","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: This study explored the effects of four different surgical methods in the treatment of cesarean scar pregnancy (CSP).

Methods: In this multicenter retrospective analysis of 359 patients, the surgical indices, the time taken for the serum human chorionic gonadotropin level to return to normal, the recovery time of menstruation, and the incidence of postoperative adverse reactions were comparatively analyzed. The clinical efficacies of various preoperative treatment methods to block the blood supply to CSP tissues and those of four different surgical methods to treat CSP, namely, curettage, hysteroscopic surgery, laparoscopic surgery, and vaginal surgery, were evaluated in this study.

Results: Hysteroscopic pregnancy tissue removal in patients with type I CSP was found to be associated with low cost, rapid postoperative recovery, and a low incidence of postsurgical complications. Among patients with type II-III CSP, the operation success rate (96.97% for type II and 88.46% for type III) in those who underwent uterine artery embolization + curettage was lower than that in patients from the other groups (all 100%). Among patients with type III CSP who underwent transvaginal ligation of the descending uterine artery + hysteroscopic removal of the pregnancy tissues, three patients (12.5%) underwent hysteroscopic surgery under transumbilical single-port laparoscopic surveillance so as to avoid uterine perforation considering that the pregnancy tissue was only 1 mm away from the uterine plasma membrane layer.

Conclusion: Hysteroscopic surgery without pretreatment can be adopted for patients with type I CSP. In contrast, patients with type II and III CSP should be initially pretreated with vascular ligation to prevent intraoperative bleeding, followed by laparoscopic or vaginal surgery.

Trial registry: Clinical Trial Registry Number ChiCTR2000040357.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

求助全文

约1分钟内获得全文去求助

来源期刊

Advances in Therapy 医学-药学

CiteScore

7.20

自引率

2.60%

发文量

353

审稿时长

6-12 weeks

期刊介绍： Advances in Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all therapeutic areas. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Advances in Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.