24例复合妊娠患者临床资料的回顾性分析

发布时间：2018-02-24 12:39

本文关键词： 复合妊娠辅助生殖技术诊断标准治疗方案妊娠结局　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:复合妊娠是指宫腔内、外同时有胚胎种植的病理性妊娠。近年来由于辅助生殖技术及促排卵治疗的广泛应用,以及患者盆腔炎性疾病、盆腔手术史等异位妊娠高危因素发病率的增加,复合妊娠的发病率逐渐增长至约1/100。复合妊娠早期诊治的目标是旨在处理异位妊娠病灶避免致命性大出血等风险的同时,减少对宫腔内胚胎发育的影响,关于复合妊娠的诊治仍存在争议。目的:分析复合妊娠的临床特点及诊断标准,评估不同治疗方案及其妊娠结局,为复合妊娠的早期诊断与临床治疗提供经验。方法:回顾性分析2010年1月-2016年4月在山东大学齐鲁医院接受诊治的24例复合妊娠临床资料,统计分析临床特征、超声表现、治疗方案和妊娠结局情况。结果:1.24例复合妊娠患者中,2例(8.3%)自然受孕,22例(91.7%)患者接受辅助生殖技术而受孕,19例(79.2%)患者既往盆腔炎或盆腔手术史,临床表现主要为非特异性的腹痛(58.3%,14/24)、阴道流血(50%,12/24)。2.经阴道超声检查使23例(95.8%)患者得到诊断,诊断孕周7.3± 1.5w。10例患者超声可见胎芽或卵黄囊,其中8例有胎心搏动,7例表现为面包圈征,6例超声图像为不均质回声包块。24例异位妊娠组织位于输卵管,2例(8.3%)位于间质部。3.14例(58.3%)因休克、异位妊娠组织有胎心搏动、腹痛剧烈、盆腔积血等指征而接受手术治疗,其中2例接受腹腔镜手术及2例休克接受急症开腹术的患者采用全身麻醉,另10例接受硬腰联合麻醉下开腹手术。10例(41.7%)患者选择期待治疗,密切监测患者状态,常规复查超声,9例患者的异位妊娠病灶均逐渐消退,1例中转手术治疗。4.5例(20.8%)孕早、中期流产,15例(62.5%)分娩无先天畸形胎儿,4例(16.7%)随访时仍妊娠。手术组与期待组的妊娠结局,包括流产率、早产率、新生儿体重、Apgar评分等无统计学差异(P0.05),两组患者中分娩婴儿均未出现先天畸形等不良结局。结论:1.盆腔炎性疾病、输卵管不孕史是复合妊娠的高危因素,辅助生殖技术增加了复合妊娠的发病率。2.手术及麻醉未明显增加流产率、早产率、胎儿发育畸形等不良妊娠结局。3.经严格选择标准及密切监测随访,期待治疗是部分复合妊娠的合适治疗方案,可避免手术及麻醉相关的并发症。
[Abstract]:Background: compound pregnancy is a pathological pregnancy with embryo implantation both in and out of the uterus. In recent years, because of the extensive application of assisted reproductive technology and ovulation promotion therapy, and pelvic inflammatory disease in patients, With the increasing incidence of high risk factors of ectopic pregnancy, such as pelvic surgery, the incidence of complex pregnancy increases to about 1 / 100. The goal of early diagnosis and treatment of ectopic pregnancy is to avoid the risk of fatal hemorrhage and other risk of ectopic pregnancy. There is still controversy about the diagnosis and treatment of complex pregnancy. Objective: to analyze the clinical characteristics and diagnostic criteria of complex pregnancy and to evaluate the different treatment schemes and pregnancy outcome. Methods: the clinical data of 24 cases of complex pregnancy from January 2010 to April 2016 in Qilu Hospital of Shandong University were analyzed retrospectively. Results among 1.24 cases of complex pregnancy, 2 cases (8.3%)) 22 cases of spontaneous pregnancy and 22 cases (91.7%) received assisted reproductive technology, while 19 cases (79.2%) had a history of pelvic inflammatory disease or pelvic surgery. The main clinical manifestations were non-specific abdominal pain of 58.3 / 24, vaginal bleeding of 50 / 12 / 24 / 2.Transvaginal ultrasonic examination made 23 cases (95. 8%) diagnosed. The diagnosis was 7. 3 卤1. 5w.10 cases of gestational age showed fetal bud or yolk sac on ultrasound. Among them, 8 cases of fetal cardiac pulsation showed baker's sign. 6 cases showed irregular echo mass. 24 cases of ectopic pregnancy tissue were located in tubal tubal tubal. 2 cases were located in interstitial part. 3.14 cases (58.3%) were in shock, ectopic pregnancy tissue had fetal heart beat and severe abdominal pain. Two patients underwent laparoscopic surgery and two patients with shock undergoing emergency laparotomy were treated with general anesthesia, and the other 10 patients received laparotomy under combined epidural anesthesia, 10 patients underwent laparotomy under epidural anesthesia, and 10 patients received surgery under epidural anesthesia. The status of the patients was closely monitored, and the focus of ectopic pregnancy in 9 cases of ectopic pregnancy was gradually receded by routine ultrasound examination. The first trimester of pregnancy was found in 1 case, which was transferred to surgical treatment (4.5 cases, 20. 8%). During the follow-up period, pregnancy was still observed. The pregnancy outcome, including abortion rate and preterm delivery rate, in the operation group and the expectant group, included abortion rate and premature delivery rate. There was no significant difference in Apgar score between the two groups. There were no adverse outcomes such as congenital malformation in both groups. Conclusion: 1. Pelvic inflammatory disease and history of tubal infertility are high risk factors for complex pregnancy. Assisted reproductive technology increased the incidence of complex pregnancy. 2. Surgery and anesthesia did not significantly increase abortion rate, premature delivery rate, fetal malformation and other adverse pregnancy outcomes .3. after strict selection of criteria and close monitoring follow-up, Expectant treatment is an appropriate treatment for partial complex pregnancy, which can avoid complications related to surgery and anesthesia.
【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】：R714.2

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