超声监视下清宫术治疗孕囊型剖宫产术后子宫瘢痕妊娠291例临床分析

发布时间：2018-03-05 13:43

  本文选题：超声监视下清宫术　切入点：孕囊型剖宫产术后子宫瘢痕妊娠　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:超声监视下清宫术是剖宫产术后子宫瘢痕妊娠(cesarean scar pregnancy,CSP)治疗中最常用的一种手术方法,其具有操作简单,费用低,损伤小,恢复快等优点。通过分析291例以超声监视下清宫术作为初始治疗方法的孕囊型CSP患者的不同临床结局,探讨超声监视下清宫术失败的相关因素以及失败后宫腔填塞压迫止血再失败的相关因素,旨在总结孕囊型CSP的处理经验。方法:1回顾性分析2006年7月至2016年7月间于河北医科大学第二医院妇科行超声监视下清宫术治疗的291例孕囊型CSP患者的病历资料。2清宫术中发生子宫出血并且需要进一步治疗的为清宫失败组,无子宫出血和子宫出血不需要进一步治疗的为清宫成功组;清宫失败组中宫腔填塞压迫止血无效而行子宫动脉栓塞术的为宫腔填塞压迫失败组,有效的为宫腔填塞压迫成功组。3应用卡方检验,Fisher精确概率法及Logistic回归模型分析清宫失败和宫腔填塞压迫止血失败的相关因素。结果:1超声监视下清宫术作为孕囊型CSP的初始治疗方法,清宫成功率为84.2%(245/291),失败率为15.8%(46/291)。46例超声监视下清宫失败的孕囊型CSP患者,宫腔填塞压迫止血成功率为71.7%(33/46),28.3%(13/46)患者因宫腔填塞压迫止血失败而行子宫动脉栓塞术,血止后行子宫瘢痕妊娠病灶切除+瘢痕子宫修补术。2超声监视下清宫术成功组与失败组病历资料对比,统计分析结果示:术前血HCG水平,心管搏动,头臀长,孕囊最大径线,超声分型,瘢痕肌层厚度及血流分级差异均有统计学意义(P0.05)。表明越高的术前血HCG水平,孕囊有心管搏动,越长的头臀长,孕囊最大径线≥3cm,超声分型中Ⅲ型,瘢痕肌层厚度≤3mm,越丰富的血流与清宫失败有关。差异有统计学意义的变量构建Logistic回归模型进行多变量回归分析示:超声监视下清宫术失败的危险因素是超声分型(OR 7.773,95%CI3.038-19.885),头臀长(OR 5.561,95%CI 2.974-10.400),血流分级(OR2.420,95%CI 1.400-4.183),术前血HCG水平(OR 1.914,95%CI1.113-3.293)。3超声监视下清宫术失败组中,宫腔填塞压迫成功组与失败组(行子宫动脉栓塞+子宫瘢痕妊娠病灶切除+瘢痕子宫修补术)的病历资料对比,统计分析结果示:术前血HCG水平,头臀长,血流分级差异均有统计学意义(P0.05)。表明术前血HCG值30000m IU/m L,头臀长14mm,越丰富的血流与宫腔填塞压迫止血失败有关。差异有统计学意义的变量构建Logistic回归模型进行多变量回归分析示:宫腔填塞压迫止血失败的危险因素是血流分级(OR 19.738,95%CI2.596-150.058)。结论:1超声监视下清宫术治疗Ⅰ型孕囊型CSP成功率较高。2超声分型中Ⅲ型,头臀长越长,孕囊及其周围血流越丰富,术前血HCG水平越高,清宫失败的可能性越大。3超声监视下清宫术失败后,孕囊及其周围血流越丰富,宫腔填塞压迫止血失败的风险相对较高,子宫动脉栓塞术是较合适的选择。
[Abstract]:Objective: Ultrasonography is one of the most commonly used procedures in the treatment of uterine scar pregnancy after cesarean section, which has the advantages of simple operation, low cost and little injury. By analyzing the different clinical outcomes of 291 cases of gestational sac type CSP treated with ultrasound monitoring hysteroscopy as the initial treatment, To investigate the factors related to the failure of uterine cavity tamponade under ultrasound monitoring and the factors related to the failure of uterine cavity packing and compression to stop bleeding. To summarize the experience in the management of gestational sac type CSP. Methods: a retrospective analysis of 291 cases of pregnant women with CSP treated by ultrasonography during July 2006 to July 2016 in the second Hospital of Hebei Medical University was carried out in the department of gynecology of the second Hospital of Hebei Medical University. (2) uterine bleeding during the clearance of the uterus and the need for further treatment are in the failed group, The successful group without uterine bleeding and uterine bleeding need no further treatment; the group with uterine cavity tamponade and hemostasis and uterine artery embolization with uterine artery embolization are the failed group of uterine cavity tamponade and compression. In the successful group of intrauterine tamponade and compression, using chi-square test, Fisher accurate probability method and Logistic regression model were used to analyze the factors related to the failure of uterine clearance and uterine packing and hemostasis. Results under the monitoring of 1: 1 ultrasound, uterine clearance was used as the gestational sac. The initial treatment of CSP, The success rate of clearing the uterus was 84.2 / 245 / 291, and the failure rate was 15.80.46 / 291g / 46 cases of pregnancy sac type CSP patients who failed to clear the uterus under the monitoring of ultrasound, and the success rate of uterine cavity tamping and hemostasis was 71.7% / 46% / 28.3% / 13 / 46) patients underwent uterine artery embolization because of the failure of uterine cavity packing compression and hemostasis. Uterine scar pregnancy focus resection scar uterine repair. 2 comparison of medical records between the successful group and the failed group under ultrasound monitoring. The results showed that: preoperative blood HCG level, cardiac tube pulsation, head and hip length, maximum gestational sac diameter, There were significant differences in the thickness of scar myometrium and blood flow grade in ultrasonic classification (P 0.05). The results showed that the higher the preoperative HCG level, the longer the heart tube pulsation, the longer the length of the head and hip, the greater the diameter of the gestational sac and the greater the diameter of the gestational sac. The thicker the thickness of scar muscle layer 鈮，

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