Application of laparoscopic internal iliac artery temporary occlusion and uterine repair combined with hysteroscopic aspiration in type III cesarean scar pregnancy

Abstract

To investigate the efficacy and safety of laparoscopic internal iliac artery temporary occlusion and uterine repair combined with hysteroscopic aspiration in type III cesarean scar pregnancy. 135 cases of cesarean scar pregnancy in Guangzhou Women and Children's Hospital from November 2017 to November 2020 were collected and 32 cases of type III patients were retrospectively analyzed. They were divided into internal iliac artery temporary occlusion (IIATO) group (21 cases), and bilateral uterine artery embolization (UAE) group (11 cases). The general condition, intraoperative bleeding, postoperative complications, and prognosis of the two groups were analyzed. In the IIATO group, the bilateral internal iliac arteries were temporarily blocked with No. 10 silk thread under laparoscopy. The scar pregnancy clearance and repair of the scar were performed after incision. Subsequently, we performed hysteroscopic aspiration. After the operation, the internal iliac artery ligation thread was removed. In the UAE group, the patients were treated with bilateral uterine artery embolization. Laparoscopic uterine scar repair and hysteroscopy aspiration were performed within 24 hours after embolization. There was no significant difference in age, times of pregnancy, times of cesarean section and gestational weeks between the two groups (P>0.05). No significant differences were observed in the diameter of gestational sac or gestational mass and serum human chorionic gonadotropin (β-hCG) level between the two groups before operation (P>0.05). The operations were successfully completed in 32 patients, and intraoperative blood loss was 67.14±32.78 ml and 71.35±31.56 ml, respectively (P<0.05). The length of hospital stay was 5.14±0.32 day and 4.97±0.21 day, respectively. No peri-procedural bleeding occurred and no secondary surgeries were required. Laparoscopic internal iliac artery temporary occlusion and uterine repair combined with hysteroscopic aspiration is an effective and safe treatment for type III cesarean scar pregnancy, with less postoperative complications and better protection of fertility function for patients.

Keywords: Internal iliac artery temporary occlusion (IIATO); cesarean scar pregnancy (CSP); uterine artery embolization (UAE).

Figure 1

Laparoscopic internal iliac artery temporary occlusion. U: uterine, F: fallopian tube, A: right internal iliac artery.