异位妊娠诊断与介入治疗的综合评价

发布时间：2018-03-27 23:34

  本文选题：异位妊娠　切入点：诊断　出处：《郑州大学》2014年硕士论文

【摘要】：背景和目的： 异位妊娠(Ectopic Pregnancy, EP)俗称宫外孕(Extrauterine pregnancy)。是指孕卵着床于子宫体腔以外的部位,可发生于任何生育期年龄的妇女,是临床妇产科常见的急腹症之一。目前EP的发生率约占妊娠总数的2%,但病死率约占孕产妇死亡总数的10%左右。结合临床症状、超声及血β-HCG及其它影像学检查对绝大多数EP早期即可做出明确诊断,因此明确诊断的同时采取最好的治疗方案是目前临床上治疗EP的关键。 分析82例EP的临床表现、实验室资料、影像学表现及介入治疗的疗效,以探讨不同类型的EP的早期临床表现、影像学特点及恰当的介入治疗方法,寻求早期诊断和提高疗效的新途径。 材料和方法： 收集2009年12月至2013年3月间,郑州市妇幼保健院和郑州市第一人民医院的82例异位妊娠患者的临床、实验室、病理、影像及介入治疗资料。年龄18-38岁,停经天数37-50天,其中输卵管妊娠52例,宫颈妊娠10例,子宫瘢痕切口妊娠20例。进行子宫动脉药物灌注及栓塞术治疗,腹腔镜手术治疗和输卵管碘油造影术检查。 临床症状主要是停经、腹痛和阴道流血,血β-HCG值明显升高。 子宫动脉药物灌注及栓塞术,采用Seldinger技术穿刺右侧股动脉,再超选子宫动脉灌注药物及明胶海绵栓塞,直至子宫动脉主干远端栓塞造影呈“截断征”。 结合影像资料根据胚囊所在的位分为输卵管妊娠(tubal pregnancy)、卵巢妊娠(ovarian pregnancy)、腹腔妊娠(abdominal pregnancy)、阔韧带妊娠(broad ligament pregnancy)、宫颈妊娠(cervical pregnancy)、鐕子宫残角妊娠(pregnancy in rudimentary horn)及近年来愈来愈多的剖腹产后所致的瘢痕妊娠(caesarean scarpregnancy, CSP)等。其中输卵管妊娠最常见,约占整个异位妊娠的95%。临床表现分析： 收集患者的主要临床症状、初始症状、初始症状的组间分布情况、生育史及生育方式。实验室资料研究分析： 分别于术前1天、术后1天、2天或3天及二周内清晨空腹抽取静脉血3m1进行血值β-HCG检测,对不同时期的β-HCG值变化进行分析。影像学资料分析： 影像分析采用双盲法。由2位有经验的影像科医师分别进行分析。结果一致的作为诊断结果,对有争议的结果再由第三位影像科医生观察、分析,结果与以前的相对照,一致的作为诊断和测量结果,以保证结果的准确、可靠。影像分析包括：①胚囊的位置；②胚囊的大小、有无胚芽及胎心搏动；③胚囊周围的情况；④盆腔内有无积液。治疗分析： 治疗方法包括：①子宫动脉药物灌注及栓塞术治疗,②腹腔镜手术治疗,分析并研究组间治疗方法以及术后疗效、术后并发症发生率、住院时间关系。介入术后疗效分析以及术前、术后血β-HCG的变化及术中出血量多少的评价。 数据处理由SPSS13.0统计软件包完成。年龄、症状出现的天数、血β-HCG测定值及各数据以均数±标准差表示,组间平均值的比较采用独立样本的t检验或配对样本的t检验,组间发生率的比较采用x2检验或Fisher's精确概率检验；计数资料以率(%)表示,组间血β-HCG的术前、术后测定数据采用重复测量设计的方差分析以检验不同水平间差异是否有统计学意义；各组数据的差别以p0.05具有统计学意义。 结果： 1.大多数患者是以停经、不规则阴道出血和腹痛为初始症状的,而流产史和剖宫产史在异位妊娠中所占的比例也很高。流产史占85.4%,剖宫产史占43.9%。 2.经阴道彩色多普勒超声检查在对输卵管妊娠诊断.比经腹部彩色多普勒超声检查诊断率明显提高。 3.52例输卵管妊娠随机分成两组,一组行腹腔镜下手术治疗(A组),一组行介入手术治疗(B组)。两组患者年龄、停经时间、治疗前血β-HCG值及异位妊娠包块最大直径比较差异无统计学意义(P0.05)。两组患者的术后常见并发症并无明显差异。两组患者的术后输卵管再通率有明显差异,介入手术治疗后比腹腔镜手术治疗后输卵管再通率明显提高。 4.子宫切口妊娠患者本组20例中,所有病例均在7周前确诊,年龄主要集中在25-35岁之间的最佳生育年龄阶段,本组占18例,占80%。 5.10例不同部位异位妊娠子宫动脉介入治疗后2-3天血β-HCG值较术前明显下降。 6.7例特殊部位异位妊娠子宫动脉介入治疗后择期清宫出血量明显减少。 7.对于子宫切口妊娠和宫颈妊娠,介入治疗比腹腔镜治疗条件范围更广,术中出血量少,且能最大限度的保留正常的生理结构。
[Abstract]:Background and purpose:
Ectopic pregnancy (Ectopic Pregnancy EP) commonly known as ectopic pregnancy (Extrauterine pregnancy). Refer to the antiimplantation in the uterine cavity outside parts, can occur in any reproductive age women, is one of the common clinical acute abdomen of Obstetrics and gynecology. The incidence of EP in pregnancy accounted for about 2% of the total, but the mortality rate is about accounted for about 10% of the total maternal death. Combined with clinical symptoms, ultrasound and serum -HCG and other imaging examination to make most of the early EP can be diagnosed at the same time, so the diagnosis of take the best treatment plan is the key to the current clinical treatment of EP.
Objective to analyze the clinical manifestations, laboratory data, imaging findings and interventional treatment effect of 82 cases of EP, so as to explore the early clinical manifestations, imaging features and appropriate interventional treatment of different types of EP, so as to find a new way to early diagnose and improve curative effect.
Materials and methods:
From December 2009 to March 2013, the MCH Hospital of Zhengzhou city and Zhengzhou city first people's Hospital of 82 cases of ectopic pregnancy in patients with clinical, laboratory, pathological, imaging and interventional therapy. 18-38 years of age, menopause in 37-50 days, of which 52 cases of tubal pregnancy, 10 cases of cervical pregnancy, 20 cases of uterine scar pregnancy incision. Uterine artery drug perfusion and embolization treatment, laparoscopy and hysterosalpingography were examined.
The main clinical symptoms were menopause, abdominal pain and vaginal bleeding, and the value of blood beta -HCG was significantly increased.
Uterine artery infusion and embolization were performed with Seldinger technique to puncture the right femoral artery, and then superselective uterine artery infusion and gelatin sponge embolization until the main artery of uterine artery was embolized.
Combined with the image data according to the embryo sac were divided into tubal pregnancy (tubal pregnancy), ovarian pregnancy (ovarian pregnancy), abdominal pregnancy (abdominal pregnancy), broad ligament pregnancy (broad ligament pregnancy), cervical pregnancy (cervical pregnancy), Zan pregnancy in rudimentary horn (pregnancy in rudimentary horn) and the scar in recent years more and more the caesarean section caused by pregnancy (caesarean scarpregnancy, CSP). The tubal pregnancy is the most common, accounting for 95%. analysis of clinical manifestations of the ectopic pregnancy:
The main clinical symptoms, initial symptoms, the distribution of the initial symptoms, the history of birth and the way of birth were collected, and the laboratory data were studied and analyzed.
Blood samples were collected from 1 days, 1 days, 2 days, 3 days, and two weeks before operation, and the venous blood 3M1 was collected at the early morning, and the blood -HCG was detected. The change of beta -HCG in different periods was analyzed.
Double blind was used in image analysis. By 2 experienced radiologists were analyzed. Results the same as the diagnostic results for controversial results by the third imaging doctors observation, analysis, compared with previous results, the same as the diagnosis and measurement results, to ensure accurate results. Reliable. Image analysis includes: the position of the embryo sac; embryo sac size, there is no embryo and fetal heart beat; the embryo sac around the case; the pelvic effusion treatment analysis:
The treatment methods included: uterine artery infusion and embolization, the laparoscopic surgery, analysis and treatment study group between the method and the curative effect after operation, the incidence of postoperative complications and hospitalization time. After intervention therapy and analysis of preoperative and postoperative changes of serum beta -HCG in postoperative evaluation of how much blood.
The data processed by SPSS13.0 statistical software. The age, number of symptoms, and the data expressed as the mean + SD. Determination of serum beta -HCG, the average value of the groups were compared using t test or paired samples of independent samples t test was used to compare groups, the incidence of x2 test or Fisher's exact probability test; count data to rate (%) said that the group of blood beta -HCG before operation. The data were analyzed by analysis of variance of repeated measurement design to test whether there is difference between different levels of statistical significance after determination; each data difference in P0.05 with statistical significance.
Result锛，

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