50例剖宫产后瘢痕妊娠的临床分析

发布时间：2018-02-03 14:55

本文关键词： 子宫动脉栓塞术瘢痕妊娠清宫术甲氨蝶呤　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:在此论文中,作者将对比两种剖宫产后瘢痕妊娠的治疗方式,即应用子宫动脉栓塞术联合甲氨蝶呤化疗后清宫治疗瘢痕妊娠,与未行子宫动脉栓塞术,单用甲氨蝶呤化疗后清宫治疗瘢痕妊娠对于剖宫产术后瘢痕妊娠的治疗效果、术后不良反应、住院时长及术后随访的差异。方法:选取山东大学附属山东省立医院2013年12月至2016年12月以"剖宫产术后子宫瘢痕妊娠"诊断出院的患者,选取资料可靠且完整的50例病例,分为应用子宫动脉栓塞术联合甲氨蝶呤化疗治疗的联合实验组(A组)与未行子宫动脉栓塞术单用甲氨蝶呤化疗后清宫治疗的对照观察组(B组),进行回顾性分析。应用SPSS软件进行统计学分析。结果:1.两组患者年龄、妊娠次数、剖宫产次数、妊娠天数、首次血清人绒毛膜促性腺激素β亚单位值及超声病灶大小等无统计学差异(p0.05)。两组比较无统计学意义(p0.05)。2.入选50例患者均达治愈标准,联合实验组患者血清β-hCG值恢复正常时间与对照观察组患者血清β-hCG值恢复正常时间差异具显著性,即治疗效果具显著差异性,联合实验组指标下降较快(p0.05)。3.联合实验组25例患者中有3例术后出现下腹胀痛,1例术后持续出血多日,1例术后出现高热(38°C),2例术后出现经量过少;B组25例患者中2例术后出现高热(38° C),2例出现术后出血量较大(500ml),又急行子宫动脉栓塞术。两组术中及术后首日出血量具统计学差异(p0.05),联合实验组出血量明显减少,联合实验组住院时长与对照观察组对比具有统计学差异(p0.05)。结论:1.子宫动脉栓塞术联合甲氨蝶呤化疗后清宫治疗瘢痕妊娠与单用甲氨蝶呤化疗后清宫治疗瘢痕妊娠相比疗效优越,在降低血清人绒毛膜促性腺激素水平方面具显著差异性。2.子宫动脉栓塞术联合甲氨蝶呤化疗后清宫治疗瘢痕妊娠与单用甲氨蝶呤化疗后清宫治疗瘢痕妊娠相比清宫术中及术后首口出血量少,具显著差异性。3.子宫动脉栓塞术费用较高,术后有时会发生不良反应。由于技术、设备等多方面因素,基层医院较难以开展子宫动脉介入栓塞技术。大型三甲医院在剖宫产术后瘢痕妊娠的诊治方面将体现出明显的先发优势。
[Abstract]:Objective: in this paper, the author will compare the two treatment methods of scar pregnancy after cesarean section, that is, uterine artery embolization combined with methotrexate chemotherapy for the treatment of scar pregnancy, and no uterine artery embolization. Treatment of scar pregnancy after chemotherapy with methotrexate alone for scar pregnancy after cesarean section, adverse reaction after operation. Methods: from December 2013 to December 2016, the patients who were diagnosed and discharged by "uterine scar pregnancy after cesarean section" were selected from Shandong Provincial Hospital affiliated to Shandong University. Fifty cases with reliable and complete data were selected. Divided into uterine artery embolization combined with methotrexate chemotherapy group (group A) and uterine artery embolization only after methotrexate chemotherapy of the control group B). Retrospective analysis. SPSS software was used for statistical analysis. Results: 1. Two groups of patients age, pregnancy times, cesarean section times, pregnancy days. For the first time, there was no significant difference in the 尾 subunit value of human chorionic gonadotropin and the size of ultrasound focus between the two groups. All 50 patients reached the standard of cure. The recovery time of serum 尾 -hCG in the combined experimental group and the control group was significantly different from that in the control group, that is, there was significant difference in the therapeutic effect. In the combined experimental group, the index decreased more rapidly (p 0.05N 路3). In the combined experimental group, 3 of the 25 patients had lower abdominal distending pain and 1 patient had sustained bleeding for many days. One patient had high fever 38 掳C after operation. The menstrual volume was too low in 2 cases after operation. In group B, 2 out of 25 patients had postoperative hyperthermia 38 掳C trochanter and 2 had postoperative bleeding volume of 500 ml. Uterine artery embolization was performed in both groups. There was a significant difference in the volume of blood loss between the two groups during operation and the first day after operation (P 0.05), and the amount of blood loss in the combined experimental group was significantly decreased. The length of hospitalization in the combined experimental group was significantly different from that in the control group (p 0.05). Conclusion 1. Uterine artery embolization combined with methotrexate chemotherapy in the treatment of scar pregnancy is more effective than single methotrexate chemotherapy in the treatment of scar pregnancy. There is significant difference in reducing serum levels of human chorionic gonadotropin. 2. Uterine artery embolization combined with methotrexate chemotherapy in the treatment of scar pregnancy and after single methotrexate treatment of scar pregnancy phase. The volume of blood loss was less than that in the operation of the Qing palace and the first mouth after operation. The cost of uterine artery embolization is high, and sometimes adverse reactions occur after operation, due to many factors, such as technology, equipment and so on. It is difficult to carry out uterine artery interventional embolization in primary hospitals, and the diagnosis and treatment of scar pregnancy after cesarean section in large third Class A hospitals will show obvious preemptive advantages.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.22

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