输卵管妊娠不同保守方案治疗后生育结局的比较

发布时间：2018-04-16 00:22

本文选题：输卵管妊娠 + 保守治疗　；参考：《广州中医药大学》2016年硕士论文

【摘要】：目的：本课题通过回顾性研究,分析不同治疗方法对输卵管妊娠后生育结局的影响,并分析影响生育结局的因素,比较不同保守治疗方法对输卵管通畅情况的影响。从而为输卵管妊娠患者提供一定的指导。方法：采用回顾性研究方法收集2009年至2015年3月因输卵管妊娠在广州中医药大学第一附属医院住院行保守治疗的患者,详细记录患者的相关病史,其主要内容包括：一般情况,病史特点(如既往史、孕产史),住院情况,辅助检查,治疗方式,随访1年以上的生育情况及输卵管的通畅情况等。将所收集的数据输入SPSS22中进行统计分析。结果：1.输卵管妊娠的治疗方式：本院自2009-2015年共收治输卵管妊娠患者1531例,其中药物保守治疗占55%,手术治疗占45%,7年间的治疗情况比较差异无统计学意义(P0.05)。2.住院天数及住院费用的比较：输卵管妊娠患者采用不同治疗方式,其住院天数及住院费用有区别。其中腹腔镜下剖管取胚术可以缩短患者的住院时间,药物保守治疗可以降低患者的住院费用。3.随访1年以上的生育结局：随访成功的输卵管妊娠患者为121例。其中中药组30例、西药组25例、中西医结合组35例、剖管取胚组31例。中药治疗组的宫内妊娠率为67.0%(20例),西药治疗组48%(12例),中西医结合治疗组69%(24例),剖管取胚组61%(19例),四组间比较差异无统计学意义(P0.05)。其中中药组、西药组、中西医结合组、剖管取胚组的再次异位妊娠率分别为10%、36%、11%、29%,四组间比较差异有统计学意义(P0.05)。中药组、西药组、中西医结合组、剖管取胚组的不孕率分别为23%、16%、20%、10%,四组间比较差异无统计学意义(P0.05)。4.不同时期宫内妊娠情况：治疗后宫内妊娠有75例,其中1年内的宫内妊娠有41例(55%),2年内的宫内妊娠有69例(92%),3至5年的宫内妊娠有6例(8%),说明输卵管妊娠后2年内是最佳受孕时间。四组间不同时期的宫内妊娠比较无统计学差异(P0.05)。5.输卵管通畅情况：输卵管妊娠患者在保守治疗后3-6月有57例行输卵管造影检查。中药组的患侧通畅率为87%(13例),对侧通畅率为93%(14例)；西药组患侧及对侧通畅率分别为70%(7例)、80%(8例)；中西医结合组分别为88%(15例)、82%(14例)；剖管取胚组分别为47%(7例)、80%(12例),四组间患侧输卵管通畅率比较有统计学差异(P0.05),四组对侧输卵管通畅率比较无统计学差异(P0.05)。6.影响患者治疗后生育结局的因素：患者的年龄、盆腔炎史、不孕史、既往异位妊娠史是影响患者生育结局的主要因素。结论：中药治疗、中西医结合治疗在降低患者的再次异位妊娠率及提高输卵管通畅率中有着独特的优势,因而在严格掌握药物治疗的适应症时,可采用中药治疗或中西医结合治疗以保护患者的生育能力。与本次治疗方法相比,患者既往的病例特点对治疗后的生育结局影响更大。
[Abstract]:Objective: to analyze the influence of different treatment methods on the outcome of tubal pregnancy and the factors influencing the outcome of tubal pregnancy, and to compare the effects of different conservative treatments on the patency of fallopian tube.So as to provide certain guidance for patients with tubal pregnancy.Methods: retrospective study was used to collect the patients who received conservative treatment for tubal pregnancy in the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine from 2009 to March 2015.The characteristics of medical history (such as previous history, history of pregnancy and childbirth, hospitalization, auxiliary examination, treatment method, fertility status of more than one year follow-up and patency of fallopian tubes, etc.)Input the collected data into SPSS22 for statistical analysis.The result is 1: 1.Treatment of tubal pregnancy: 1531 cases of tubal pregnancy were treated in our hospital from 2009 to 2015, of which 55 cases were treated with conservative drug therapy, and there was no significant difference in the treatment of surgical treatment in 45 years.Comparison of hospitalization days and hospitalization expenses: different treatment methods were used in tubal pregnancy patients, and their hospitalization days and expenses were different.Laparoscopy can shorten the duration of hospitalization, and conservative drug therapy can reduce the cost of hospitalization.Following up for more than one year: 121 cases of tubal pregnancy were followed up successfully.There were 30 cases in Chinese medicine group, 25 cases in western medicine group, 35 cases in integrated Chinese and western medicine group and 31 cases in tube extraction group.The intrauterine pregnancy rate was 67.0 in the traditional Chinese medicine treatment group, 12 in the western medicine treatment group, 69 in the combined Chinese and western medicine treatment group, and 19 in the tube taking embryo group. There was no significant difference among the four groups (P 0.05).Among them, the ectopic pregnancy rate of the traditional Chinese medicine group, western medicine group, integrated Chinese medicine group and tube extraction group were 103636 and 111.29, respectively. The differences among the four groups were statistically significant (P 0.05).The infertility rate of the traditional Chinese medicine group, the western medicine group, the integrated traditional Chinese and western medicine group and the tube taking embryo group were 23 and 16, 20 and 10, respectively. There was no significant difference among the four groups (P 0.05. 4).During different periods of intrauterine pregnancy, there were 75 cases of intrauterine pregnancy after treatment.There were 41 cases of intrauterine pregnancy within 1 year, 69 cases of intrauterine pregnancy within 2 years, and 6 cases of intrauterine pregnancy of 3 to 5 years, indicating that 2 years after tubal pregnancy was the best time to conceive.There was no significant difference in intrauterine pregnancy between the four groups at different stages (P 0.05. 5).Tubal patency: 57 cases of tubal pregnancy were examined by salpingography 3-6 months after conservative treatment.The patency rate of the diseased side in the traditional Chinese medicine group was 87 cases and the contralateral patency rate was 93%. In the western medicine group, the patency rates of the affected side and the opposite side were 70 and 7 cases, respectively. In the integrated Chinese and western medicine group, there were 8815 cases and 8214 cases, respectively.There was statistical difference in the rate of tubal patency in the affected side (P 0.05), but there was no significant difference in the rate of tubal patency in the four groups (P 0.05).Factors influencing the outcome of fertility after treatment: the patient's age, history of pelvic inflammatory disease, history of infertility and history of ectopic pregnancy were the main factors affecting the outcome of fertility.Conclusion: traditional Chinese medicine treatment and integrated traditional Chinese and western medicine therapy have unique advantages in reducing the rate of ectopic pregnancy and improving the rate of tubal patency.Can be treated with traditional Chinese medicine or integrated Chinese and western medicine treatment to protect the fertility of patients.Compared with this treatment, the characteristics of past cases have a greater impact on the outcome after treatment.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R714.221

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