剖宫产瘢痕妊娠临床处理方案比较分析

发布时间：2018-04-12 06:29

  本文选题：剖宫产瘢痕妊娠 + 刮宫术　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的分析比较本院治疗剖宫产瘢痕妊娠的选择方式及临床疗效。方法收集本院2016年1月至2016年12月收治的274例剖宫产瘢痕妊娠患者,根据不同的处理方式进行分组及统计分析。A组:直接B超引导下刮宫术(备子宫动脉栓塞术)193例。B组:双侧子宫动脉栓塞术+甲氨蝶呤动脉灌注化疗+B超引导下刮宫术74例。C组:宫腔镜下子宫峡部妊娠物电切割(伴或不伴双侧子宫动脉栓塞术+甲氨蝶呤动脉灌注化疗)2例。D组:剖宫取胎(术前72小时内予双侧髂内动脉球囊置入术或双侧子宫动脉栓塞术处理)5例。C、D两组例数较少,统计困难。本文主要比较A、B两组孕周、胚囊大小、瘢痕厚度、瘢痕处血流、术中出血量、术前血人绒毛膜促性腺激素水平、血人绒毛膜促性腺激素下降速率、术后并发症发生比例、再入院比例、术后住院时间、住院费用情况。结果我院2016年1月至2016年12月收治的274例剖宫产瘢痕妊娠患者中,Ⅰ型剖宫产瘢痕妊娠占34.0%,Ⅱ型占57.6%,Ⅲ型占8.4%。因彩色多普勒超声检查发现异常入院的剖宫产瘢痕妊娠患者占39.4%,因阴道流血入院的占48.5%,因腹痛入院的占3.7%,因阴道流血伴腹痛入院的占2.2%,要求终止妊娠入院的占6.2%。A组:193例剖宫产瘢痕妊娠患者手术治疗均成功,未发生术中并发症,孕周小于等于7周者59.6%,胚囊小于等于2.5cm者61.5%,瘢痕厚度大于等于3mm者47.2%,瘢痕处血流不丰富者65.2%,平均术前人绒毛膜促性腺激素水平(40342±45897)IU/L,术中出血量小于等于100ml者96.9%,术后平均人绒毛膜促性腺激素下降速率(67.0±11.2)%,术后平均住院时间(4.5±1.6)天,平均住院费用(3489.1±2258.1)元,术后再入院者3.1%。B组:74例剖宫产瘢痕妊娠患者手术均成功,发生术中并发症者39.2%,孕周小于等于7周者43.2%,胚囊小于等于2.5cm者30.6%,瘢痕厚度大于等于3mm者17.6%,瘢痕处血流不丰富者22.5%,平均术前HCG水平(69257±59676)IU/L,术中出血量小于等于100ml者91.9%,术后平均HCG下降速率(73.9±11.2)%,术后平均住院时间(6.4±1.9)天,平均住院费用(12230.8±1624.6)元,术后再入院者8.1%。C组:2例剖宫产瘢痕妊娠患者手术治疗均成功,均发生术中并发症,孕周小于等于7周者50%,胚囊小于等于2.5cm者50%,无瘢痕厚度大于等于3mm者,瘢痕处血流不丰富者50%,平均术前人绒毛膜促性腺激素水平(59395.5±77110.7)IU/L,术中出血量小于等于100ml者100%,术后平均人绒毛膜促性腺激素下降速率(68.3±19.7)%,术后平均住院时间(4.5±0.7)天,平均住院费用(10125±4748.9)元,无术后再入院者。D组:5例剖宫产瘢痕妊娠患者手术治疗均成功,发生术中并发症者80%,无孕周小于等于7周者,无胚囊小于等于2.5cm者,无瘢痕厚度大于等于3mm者,瘢痕处血流不丰富者40%,平均术前人绒毛膜促性腺激素水平(75098.5±20426.2)IU/L,术中出血量小于等于100ml者20%,术后平均人绒毛膜促性腺激素下降速率(90.6±1.4)%,术后平均住院时间(9.2±3.6)天,平均住院费用(24112.8±3639.7)元,无术后再入院者。A、B两组孕周、胚囊大小、瘢痕厚度、瘢痕处血流丰富程度、术前血人绒毛膜促性腺激素水平、血人绒毛膜促性腺激素下降速率、术后并发症发生比例、术后住院时间、住院费用情况差距有统计学意义(P0.05)。A、B两组术中出血量、再入院比例差异无统计学意义(P0.05)。因C、D组例数较少,未行统计学分析。结论孕周小于等于7周者、胚囊小于等于2.5cm者、瘢痕厚度大于等于3mm者、瘢痕处血流不丰富者、术前血人绒毛膜促性腺激素水平较低者,可首选B超引导下刮宫术。反之,孕周大于7周者、胚囊大于2.5cm者、瘢痕厚度小于3mm者、瘢痕处血流较丰富者、术前血人绒毛膜促性腺激素水平较高者,可选择双侧子宫动脉栓塞术+甲氨蝶呤动脉灌注化疗+B超引导下刮宫术,且此种术式有较好的治疗效果。
[Abstract]:Objective to compare the clinical efficacy and treatment of cesarean scar pregnancy. Methods selection of our hospital from January 2016 to December 2016 were 274 cases of cesarean scar pregnancy patients, grouping and statistical analysis.A group according to the different methods: direct ultrasound guided curettage (by scraping the uterine artery embolization in 193 cases).B group: bilateral uterine artery embolization + methotrexate artery chemotherapy + ultrasound guided curettage in 74 cases.C group: Hysteroscopic uterine isthmus pregnancy electric cutting (with or without bilateral uterine artery embolization plus methotrexate arterial infusion chemotherapy) in 2 cases of.D group: Caesarean section (72 hours before surgery for bilateral iliac in artery balloon implantation or bilateral uterine artery embolization in treatment of 5 cases of.C, two D) group, the small number of cases, statistical difficulties. This paper mainly compares A, B two groups of gestational sac size, scar scar thickness, blood flow, bleeding, surgery The blood hCG levels, blood HCG decreased rate of complications after operation, the proportion, ratio of re hospitalization, postoperative hospitalization time, hospitalization cost. The results of our hospital from January 2016 to December 2016 treated 274 cases of cesarean scar pregnancy patients, type of cesarean scar pregnancy type II accounted for 34%, accounting for 57.6%, accounting for 8.4%. of type III by color Doppler ultrasound examination found abnormal hospital cesarean scar pregnancy accounted for 39.4% of patients hospitalized due to vaginal bleeding admitted to hospital because of abdominal pain accounted for 48.5%, accounted for 3.7%, because of vaginal bleeding with abdominal pain into the hospital accounted for 2.2%, to terminate the pregnancy hospital for 6.2%.A group 193 cases with cesarean scar pregnancy surgery were successful, no complications occurred, 7 weeks pregnant Zhou Xiaoyu is equal to 59.6%, the embryo sac is less than or equal to 2.5cm 61.5%, 3mm 47.2% is greater than or equal to the thickness of the scar, scar not rich blood flow in 65 .2%, the average of the previous hCG level (40342 + 45897) IU/L, the amount of intraoperative bleeding is less than or equal to 96.9% 100ml, the average human chorionic gonadotropin decreased rate of postoperative (67 + 11.2)%, the average hospitalization time after operation (4.5 + 1.6) days, the average hospitalization expenses (3489.1. 2258.1 yuan), readmission in 3.1%.B group after surgery: 74 cases of cesarean scar pregnancy patients were successful operation, complications occurred in 39.2%, 7 weeks pregnant Zhou Xiaoyu is equal to 43.2%, the embryo sac is less than or equal to 2.5cm 30.6%, 3mm 17.6% is greater than or equal to the thickness of the scar, scar not rich blood flow in 22.5% patients, the average the level of HCG (69257 + 59676) IU/L, the amount of intraoperative bleeding is less than or equal to 91.9% 100ml, the average rate decreased after HCG (73.9 + 11.2)%, the average hospitalization time after operation (6.4 + 1.9) days, the average hospitalization expenses (12230.8 + 1624.6), then the hospital after operation in 8.1%.C group: 2 cases of cesarean scar pregnancy patients Surgical treatment was successful, postoperative complications occurred, 7 weeks pregnant Zhou Xiaoyu is equal to 50%, the embryo sac is less than or equal to 2.5cm 50%, no scar thickness greater than or equal to 3mm, the scar not rich blood flow in 50% patients, the average of previous hCG levels (59395.5 + 77110.7) IU/L, the amount of intraoperative bleeding is less than or equal to 100ml 100%, the average human chorionic gonadotropin decreased rate of postoperative (68.3 + 19.7)%, the average hospitalization time after operation (4.5 + 0.7) days, the average hospitalization expenses (10125 + 4748.9) yuan, readmission in.D group after operation: 5 cases of cesarean scar pregnancy patients with surgical treatment success, complications occurred in 80%, no pregnant Zhou Xiaoyu is 7 weeks, no embryo sac is less than or equal to 2.5cm, no scar thickness greater than or equal to 3mm, the scar not rich blood flow in 40% patients, the average of previous hCG levels (75098.5 + 20426.2) IU/L, the amount of intraoperative bleeding is less than or equal to 100ml In 20%, the average human chorionic gonadotropin decreased rate of postoperative (90.6 + 1.4)%, the average hospitalization time after operation (9.2 + 3.6) days, the average hospitalization expenses (24112.8 + 3639.7), no postoperative readmission were.A, B two groups of gestational sac size, thickness of the scar, scar at the richness, preoperative blood hCG levels, blood HCG decline rate, the proportion of complications after operation, postoperative hospitalization time, hospitalization expenses gap was statistically significant (P0.05).A, B two sets of blood loss, no statistically significant differences in the proportion of readmission (P0.05). Because of the C D group, the small number of cases, without statistical analysis. Conclusion the gestational age is less than or equal to 7 weeks, the embryo sac is less than or equal to 2.5cm, the scar thickness is greater than or equal to 3mm, the scar not rich blood flow, preoperative blood HCG level is low, can be the first choice of ultrasound under the guidance of curettage and, The gestational age of more than 7 weeks, the embryo sac is greater than 2.5cm, less than 3mm thickness of the scar, scar rich blood, preoperative blood hCG levels higher, can choose bilateral uterine artery embolization + methotrexate artery chemotherapy + ultrasound guided curettage, and this kind of surgery has better effect of treatment.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.22
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本文编号：1738556