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| Analysis of the factors influencing the treatment effect of hysteroscopic and laparoscopic surgery for treating patients with cesarean scar pregnancy and their predictive efficacy for the treatment effect |
| Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Anhui Province, 241000 |
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Abstract To investigate the factors influencing the treatment effect of hysteroscopic and laparoscopic surgery for treating patients with cesarean scar pregnancy(CSP), and to study the predictive efficacy of these influence factors for the treatment effect. Methods: The clinical data of 100 patients with CSP whom were treated with hysteroscopic and laparoscopic surgery in the hospital from January 2019 to January 2024 were selected in this study. All the patients were divided into 83 cases with effective treatment in group A and 17 cases with ineffective treatment in group B according to the treatment results. The general data, the vaginal ultrasound index value, the preoperative β-human chorionic gonadotropin(β-hCG) level and other clinical data of the patients in the two groups were collected. Binary Logistic regression analysis was used to screen the factors affecting the efficacy of hysteroscopic and laparoscopic surgery for treating patients with CSP. Receiver operating characteristic(ROC) curve was used to evaluate the predictive efficacy of the influencing factors on the ineffective treatment of hysteroscopic and laparoscopic surgery. Results: Univariate analysis showed that the number of cesarean section, the gestational weeks, the type of scar pregnancy, the gestational sac volume, the muscular layer thickness of uterine scar, the blood flow classification of scar and the preoperative serum β-hCG level of the patients with CSP were related to their treatment effect by hysteroscopic and laparoscopic surgery(P<0.05). Logistic multivariate analysis showed that the exogenous type of scar pregnancy(OR=4.300), the large gestational sac volume(OR=1.674), the grade Ⅲ blood flow of the scar(OR=2.811), the less muscular thickness of the scar(OR=0.070) and the high preoperative serum β-hCG level(OR=1.003) of the patients with CSP were the influencing factors of their ineffective treatment by hysteroscopic and laparoscopic surgery(P<0.05). ROC analysis showed that all the above influencing factors had certain predictive efficacy for the ineffective treatment of the patients with CSP by hysteroscopic and laparoscopic surgery, and the area under the curve(AUC) of all the above influencing factors for predicting the efficacy of hysteroscopic and laparoscopic surgery were 0.707, 0.760, 0.727, 0.872 and 0.938, respectively. Conclusion: The type of scar pregnancy, the gestational sac volume, the blood flow classification of scar, the muscular layer thickness of uterine scar and the preoperative serum β-hCG level of the patients with CSP are all infecting their effect of hysteroscopic and laparoscopic surgery, and which all have certain predictive values for the effect of hysteroscopic and laparoscopic surgery. The patients with CSP and the risk of the ineffective treatment by hysteroscopic and laparoscopic surgery can be identified based on these influence factors early, and the corresponding measure should be conducted to improve the prognosis of the patients.
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