子宫切口妊娠不同临床处理方案比较

发布时间：2018-05-17 10:04

本文选题：子宫切口妊娠 + 子宫动脉灌注栓塞术　；参考：《天津医科大学》2014年硕士论文

【摘要】：目的：比较子宫动脉灌注栓塞术(uterus artery infusion embolization, UAIE),甲氨蝶呤(nnethotrexate, MTX)胎囊局部注射、MTX全身用药、阴式子宫切口瘢痕妊娠病灶清除术+子宫肌壁修补术(Transvaginal Cesarean Scar Pregnancy Debridement Surgery and Myometrium Neoplasty, TCSPDS-MN)治疗子宫切口妊娠(Cesarean Scar Pregnancy, C SP)的临床效果,探讨不同临床处理方案的优缺点,为子宫切口妊娠的临床治疗提供依据。方法：对2009年9月至2013年12月天津市天和医院(现天津医院)和2010年10月至2013年12月天津市中心妇产科医院的子宫切口妊娠352例进行回顾性分析,其中UAIE138例,MTX胎囊局部注射83例,MTX全身用药66例,阴式子宫切口瘢痕妊娠病灶清除术+子宫肌壁修补术65例。全面收集上述四组患者的临床病例资料,分析比较同时行清宫术者的术中出血量、手术时间、住院时间、住院费用、并发症、术后阴道出血时间、术后β-HCG下降情况,治疗成功率,并远期随访UAIE组术后及全身MTX组月经复潮时间、术后3、6个月雌二醇(E2)、促卵泡生成素(FSH)水平、卵巢大小等指标,评价子宫动脉栓灌注塞术对于卵巢功能的影响。结果： 1.阴式手术组术后阴道出血时间及住院时间最短,术后血β-HCG下降最明显,其次是UAIE组,全身MTX组最慢(F=42.89,P0.001)。 2. UAIE组手术时间及术中出血量明显少于其它三组,其次是阴式手术(F=20.42,P0.001)。阴式手术时间长于局部MTX组及UAIE组(F=41.75,P0.001)。 3.住院费用UAIE最高(平均13612±2642元),阴式手术其次,全身MTX组及局部MTX组费用无明显差异(P0.05)。 4.四组治疗方案中阴式手术组成功率最高(成功率：87.7%),全身MTX治疗最低(成功率为54.5%, F=0.12,P=0.73)；且全身MTX治疗的副反应最大。结论： 1.子宫动脉灌注栓塞术后行清宫术能充分阻断子宫动脉血流,局部MTX浓度高,大大降低术中及术后大出血的风险性,并且保留子宫完整性,对卵巢功能无明显影响,仍是目前子宫切口妊娠的首选治疗方法。 2.子宫切口瘢痕妊娠病灶清除术+子宫肌壁修补术作为一种全新的微创CSP治疗方法,具有一次完全清除病灶、保留患者生育功能、住院时间短、恢复快、术后阴道出血时间短,血β-HCG下降快等优势,日益受到临床重视,应用日益广泛。 3.MTX超声引导下胎囊局部注射治疗,毒副反应明显低于全身用药组,住院费用低,对仪器设备和医生手术技能要求低,易操作,但具有住院时间长、血β-HCG下降缓慢、阴道出血时间长等缺点,但对于低收入人群和偏远地区不失为一种良好选择。 4.MTX全身用药毒副反应相对较多,成功率低,且住院时间长,阴道出血时间长、血β-HCG下降缓慢,目前此种治疗方法不作为治疗CSP的常规方法。
[Abstract]:Objective: to compare the systemic administration of intrauterine arterial infusion embolization (artery infusion embolization,) with intrauterine injection of artery infusion embolization, methotrexate (MTX) into fetal sac. Clinical effect of Transvaginal Cesarean Scar Pregnancy Debridement Surgery and Myometrium Neoplasty, TCSPDS-MNs in the treatment of pregnancy Cesarean Scar Pregnancy, C SP) of uterine incision, the advantages and disadvantages of different clinical treatments were discussed. To provide the basis for the clinical treatment of uterine incision pregnancy. Methods: from September 2009 to December 2013, 352 cases of uterine incision pregnancy in Tianjin Tianhe Hospital (now Tianjin Hospital) and Tianjin Central Gynecology and Obstetrics Hospital from October 2010 to December 2013 were retrospectively analyzed. Among them, 66 cases were treated with UAIE138 and 66 cases were treated with MTX by local injection of fetal sac, 65 cases were treated with uterine muscle wall repair. The clinical data of the four groups were collected, and the blood loss, operation time, hospitalization cost, complications, vaginal bleeding time, and the decrease of 尾 -HCG were analyzed and compared. The success rate of treatment, and long-term follow-up of UAIE group and systemic MTX group menstrual resuscitation time, estradiol E _ 2, follicle stimulating hormone (FSH) level, ovarian size and other indicators, to evaluate the impact of uterine artery embolization on ovarian function. Results: 1. The vaginal bleeding time and hospitalization time were the shortest in the vaginal operation group, and the decrease of serum 尾 -HCG was the most obvious, followed by the UAIE group, and the slowest FV 42.89 渭 m P 0.001 in the systemic MTX group. 2. The time of operation and the amount of intraoperative bleeding in UAIE group were significantly less than those in other three groups. The time of negative operation was longer than that of local MTX group and UAIE group. 3. The cost of UAIE was the highest (mean 13612 卤2642 yuan) in hospitalization, followed by vaginal operation. There was no significant difference between systemic MTX group and local MTX group (P 0.05). 4. In the four groups, the success rate of negative operation group was the highest (success rate: 87.7%), and that of systemic MTX treatment was the lowest (the success rate was 54.5%, FG 0.12 P < 0.73%), and the side effect of systemic MTX treatment was the largest. Conclusion: 1. Uterine artery blood flow can be blocked by uterine artery infusion embolization, local MTX concentration is high, the risk of massive bleeding during and after operation is greatly reduced, uterine integrity is preserved, and ovarian function is not significantly affected. It is still the first choice of treatment for uterine incision pregnancy. 2. Repair of uterine muscle wall as a new minimally invasive CSP method for uterine incision scar pregnancy focus debridement has the advantages of complete clearance of the lesion, retention of the patient's fertility function, short hospitalization time, rapid recovery, and short postoperative vaginal bleeding time. Blood 尾-HCG has been paid more and more attention and widely used because of its rapid decline. Under the guidance of 3.MTX ultrasound, the side effect of local injection of fetal sac was obviously lower than that of the whole body medication group, the cost of hospitalization was low, the requirement of instrument and medical operation skill was low, the operation skill was easy to operate, but the hospitalization time was long, and the blood 尾 -HCG decreased slowly. Long vaginal bleeding is a good choice for low-income people and remote areas. There are relatively many side effects, low success rate, long hospital stay, long vaginal bleeding time and slow decrease of blood 尾 -HCG in 4.MTX. At present, this treatment method is not a routine method for the treatment of CSP.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713.8

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