Observation on the clinical effect of local injection of lauromacrogol and methotrexate under ultrasound intervention in the treatment of cesarean scar pregnancy in the elderly

Objective To observe the clinical effect of local injection of lauromacrogol and methotrexate under ultrasound intervention in the treatment of cesarean scar pregnancy(CSP) in the elderly. Methods Total 170 elderly patients with CSP were divided into control group(n=85) and research group(n=85) according to random number table method. The patients in the research group were treated by vacuum curettage after local injection of lauromacrogol and methotrexate, while the patients in the control group were treated by uterine artery embolization and vacuum curettage. The amount of intraoperative bleeding, length of stay, time of β-hCG turning negative, time of menstrual recovery and time of ovulation recovery were recorded. The changes of serum FSH, LH, E2 and AMH levels before and after treatment were measured. The adverse reactions and complications were observed. Results There was no significant difference between the two groups in the amount of intraoperative bleeding, the length of stay, the time of β-hCG turning negative and the time of focus disappearance(all P>0.05). The total treatment cost of the research group[(5 967.34±384.96)yuan] was significantly lower than that of the control group[(12 236.51±795.02)yuan, t=-12.985, P<0.001]. The menstrual recovery time[(36.82±3.93)d] and ovulation recovery time[(96.37±12.84)d] in the research group were significantly shorter than those in the control group[(40.69±4.31)d and(114.19±15.62) d, t=-4.196,-6.803; P<0.001]. The level of FSH in the study group was significantly lower than that in the control group, and the level of AMH and E2 was significantly higher than that in the control group at 1 months after operation(t=-3.796~2.972, all P<0.05). The overall incidence of short-term adverse reactions and long-term complications in the research group(12.94%) was significantly lower than that in the control group(27.06%), χ²=5.294, P=0.021. Conclusion Compared with uterine artery embolization, local injection of lauromacrogol combined with methotrexate under ultrasound intervention has less influence on ovarian function of elderly CSP patients, which is conducive to promoting the recovery of menstruation and ovulation function, reducing postoperative adverse reactions and complications, and reducing medical costs.