子宫动脉栓塞术和全身甲氨蝶呤治疗对剖宫产术后瘢痕妊娠疗效的对比分析

发布时间：2018-03-06 17:32

本文选题：剖宫产术后瘢痕妊娠　切入点：子宫动脉栓塞术　出处：《新疆医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨子宫动脉栓塞术联合宫腔镜手术治疗在剖宫产瘢痕妊娠临床疗效及应用价值。方法：回顾性分析新疆医科大学第一附属医院妇科2010年1月至2013年6月间收治的67剖宫产术后瘢痕妊娠患者的诊疗过程。根据患者不同的诊疗方案：分类A组35例双侧子宫动脉栓塞术(UAE)组,B组32例甲氨蝶呤(MTX)肌内注射组,两组均随后成功施行宫腔镜电切手术治疗。各组对术中出血量、住院天数、术后血-HCG转阴时间、月经恢复时间、病灶消失时间、成功率等临床指标进行比较。结果：65例患者一次性治疗成功。栓塞组和MTX组术中出血量分别为(32.00±8.06)ml和(71.41±20.7)ml；住院天数分别为(12.46±5.0)d和(16.16±5.4)d；病灶消失时间分别为(50.74±22.0)d和(68.44±35.6)d；血-HCG转阴时间分别为(37.63±12.4)d和(61.25±20.7)d,各指标比较具有显著性差异(P0.05),月经恢复时间分别为栓塞组(40.80±11.36)d和MTX组(43.38±9.9)d；月经恢复时间两组无差异(P0.05)。在MTX组1患者术后15天因严重阴道流血急诊行全子宫切除术。结论：对于治疗剖宫产术后瘢痕妊娠经子宫动脉栓塞联合宫腔镜下病灶清除术视为一种安全、有效、首选的治疗方法,能明显减少清宫过程中的出血量、缩短β-HCG值下降至正常的时间、缩短住院时间,而且创伤小,成功率高,保留了患者的生育功能,并且不影响患者的生理功能,降低了医疗风险,并其他治疗提供机会。
[Abstract]:Objective: to investigate the clinical effect and value of uterine artery embolization combined with hysteroscopic surgery in the treatment of cesarean scar pregnancy. Methods: the gynecological department of the first affiliated Hospital of Xinjiang Medical University from January 2010 to June 2013 was retrospectively analyzed. The course of diagnosis and treatment of 67 cases of scar pregnancy after cesarean section. According to the different diagnosis and treatment plan: group A (35 cases with bilateral uterine artery embolization) group B and group B (32 cases with MTX) intramuscular injection of methotrexate (MTX) were classified into three groups: group A (35 cases with bilateral uterine artery embolization) and group B (32 cases with intramuscular injection of MTX). The two groups were treated successfully by hysteroscopic electrotomy. The blood loss, hospitalization days, blood-HCG negative time, menstrual recovery time and lesion disappearance time were observed in each group. Results the intraoperative bleeding volume of embolization group and MTX group were 32.00 卤8.06ml and 71.41 卤20.7ml, respectively, the days of hospitalization were 12.46 卤5.0 days and 16.16 卤5.4 days, the time of lesion disappearance were 50.74 卤22.0d and 68.44 卤35.6d, respectively. The time of menorrhagia was 37.63 卤12.4 days and 61.25 卤20.7 days, respectively. There was significant difference between the two groups (P 0.05). The recovery time of menstruation was 40.80 卤11.36 days in the embolization group and 43.38 卤9.9 days in the MTX group, and there was no difference between the two groups in the recovery time of menstruation (P0.055.The first patient in the MTX group received emergency treatment 15 days after operation due to severe vaginal bleeding). Conclusion: it is safe to treat scar pregnancy after cesarean section by transuterine arterial embolization combined with hysteroscopic debridement. Effective, the first choice treatment method can obviously reduce the amount of blood loss in the process of clearing the uterus, shorten the 尾 -HCG value to the normal time, shorten the hospitalization time, and the trauma is small, the success rate is high, and the patient's fertility function is preserved. And does not affect the patient's physiological function, reduced medical risk, and other treatment opportunities.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713.4

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