瘢痕妊娠人工流产或清宫术中术后大量出血83例处理和预后研究

发布时间：2018-05-21 19:48

  本文选题：瘢痕妊娠 + 人流　； 参考：《中国实用妇科与产科杂志》2017年02期

【摘要】：目的探讨瘢痕妊娠人工流产(人流)或清宫术中术后出现大量出血的原因、处理方法和临床预后。方法对广州医科大学附属第三医院2005年1月至2014年12月收治的83例行人流或清宫术中术后大量出血、诊断为瘢痕妊娠患者的临床资料进行回顾性分析,包括停经天数、出血情况、处理方法、血β-h CG下降至正常时间、阴式超声监测宫内妊娠包块消失情况、治疗3个月后阴式超声瘢痕修复情况等。结果诊断:所有病例均经阴道超声、阴式三维彩超、手术或病理检查确诊为瘢痕妊娠。处理:30例人流或清宫术中术后大量出血病人(大出血组),其中5例急诊行(次)全子宫切除术控制出血,另外25例急诊行子宫动脉栓塞术,出血控制后,5例未予辅助治疗、7例辅以保守治疗、6例辅以保守手术、7例辅以清除修补术;另53例人流或清宫术后不规则阴道流血10~132 d(出血组),17例保守治疗、15例保守手术、21例清除修补术。疗效:子宫动脉栓塞术(UAE)组、保守治疗组、保守手术组或清除修补手术组治疗后阴道流血时间、血β-h CG降至正常、宫腔内异常包块消失、正常月经恢复时间、恢复后第1次月经经期、治疗后瘢痕愈合不良或者憩室比率依次减少,差异有统计学意义。结论有剖宫产史患者再次妊娠,需常规行阴式三维彩超检查,及早排除瘢痕妊娠;未明确排除者于人流或清宫术中术后大量出血,应高度警惕瘢痕妊娠;UAE是紧急控制阴道流血的有效措施,保守手术或清除修补术短期临床疗效较为确切。
[Abstract]:Objective to investigate the causes, treatment and clinical prognosis of massive bleeding in scar pregnancy induced abortion or uterine clearing. Methods from January 2005 to December 2014, 83 patients with massive bleeding during or after operation and diagnosis of scar pregnancy in the third affiliated Hospital of Guangzhou Medical University were retrospectively analyzed, including the days of menopause. Bleeding, treatment, blood 尾 -hCG decreased to normal time, vaginal ultrasound monitoring the disappearance of intrauterine pregnancy mass, after 3 months of treatment, the repair of ultrasonic scar. Results: all cases were diagnosed as scar pregnancy by transvaginal ultrasound, 3 D ultrasonography, operation or pathology. To deal with 30 cases of massive bleeding during or after operation of abortion or uterine clearing (large bleeding group), 5 cases were treated with emergency hysterectomy to control bleeding, and 25 cases were treated with uterine artery embolization. After hemorrhage control, 5 cases were not treated with adjuvant treatment, 7 cases were treated with conservative treatment, 6 cases were treated with conservative operation and 7 cases were treated with removal and repair. Another 53 cases had irregular vaginal bleeding for 10 ~ 132 days (bleeding group, 17 cases were treated conservatively, 15 cases were treated conservatively, 21 cases were removed and repaired). Curative effect: uterine artery embolization (UAE) group, conservative treatment group, conservative operation group or purge repair operation group after treatment vaginal bleeding time, blood 尾 -hCG decreased to normal, intrauterine abnormal mass disappeared, normal menstrual recovery time, In the first menstrual period after recovery, the rate of scar healing or diverticulum decreased in turn, the difference was statistically significant. Conclusion for the patients with history of cesarean section, it is necessary to routinely perform three dimensional sonography in order to remove scar pregnancy as early as possible. The UAE of scar pregnancy is an effective measure to control vaginal bleeding urgently. The short-term clinical effect of conservative operation or removal and repair is more accurate.
【作者单位】： 广州医科大学附属第三医院妇产科广东省产科重大疾病重点实验室广东省普通高校生殖与遗传重点实验室广州]，

本文编号：1920516