双侧子宫动脉栓塞术治疗胎盘植入临床分析
发布时间：2018-11-02 10:03
【摘要】：研究背景及意义: 胎盘植入(placenta implantation，PI)属于妊娠相关出血性疾病的范畴，近年来发生率和严重性不断上升。为防止难治性出血这种潜在的并发症，除了围产期子宫切除外，子宫动脉栓塞术是可以作为代替外科手术的一种新方法，已证明其对控制其他治疗无反应的产后出血的成功率超过90%。本研究分析胎盘植入的临床特点，探讨子宫动脉栓塞术治疗胎盘植入的临床疗效，产生的并发症和对未来生育的影响。 目的: 探讨我院收治的胎盘植入患者临床特点和诊断方法，并行子宫动脉栓塞术治疗的疗效、并发症。 方法: 1．收集一般资料：收集我科2006年1月至2011年12月共收治的胎盘植入患者共计110例，其中晚期妊娠患者80例，并根据治疗方法将其分为三组：①保守治疗组12例：采用药物(主要是米非司酮)保守治疗；②子宫动脉栓塞(uterine arteryembolization，UAE)组40例，采用双侧子宫动脉栓塞术治疗；③子宫切除组9例，经外科手术切除子宫。记录患者年龄、孕产次、孕周、既往史、诊断及治疗方法。 2．观察和记录的数据和指标：三组的临床结局、栓塞治疗有效率(如出血减少或停止、月经复潮或再次妊娠)和失败率(如二次栓塞、子宫切除或产妇死亡)，并比较三组患者的出血量、输血量、住院时间、手术时间、胎盘排出和月经复潮时间。由电话随访得到患者后续的关于月经和生育的信息，记录在临床随访的1年期间，正常月经复潮情况和再次妊娠情况。 3．统计学分析：应用统计学软件SPSS19.0进行统计分析，计量资料以均数±标准差（x±s）表示，行t检验或方差分析，P＜0.05表示差异有统计学意义。 结果: 1．胎盘植入的发生与患者的剖宫产史(38.18%)、刮宫史(92.73%)等子宫手术史、前置胎盘(32.73%)、年龄(30.00%)等因素有关。诊断依靠临床表现、彩超检查、病理检查三项依据。 2．子宫动脉栓塞组、子宫切除组、保守治疗组的年龄、孕周、孕次差异均无统计学意义(P＞0.05)。 3．经子宫动脉栓塞术后38例成功止血，有2例未能止血而行子宫切除术。栓塞术后未出现器官局部缺血坏死、神经损伤等严重并发症，发热、下腹痛为常见并发症。 4．子宫动脉栓塞组、子宫切除组、保守治疗组的出血和输血量、手术时间、住院天数的差异有统计学意义(P＜0.05)。 5.对UAE组患者进行为期1年的随访，除9例失访病例，其余患者在随访时间内恢复正常月经，并有2例再次妊娠者。 结论: 1.胎盘植入发生率随时间有增加趋势。胎盘植入的诊断以临床诊断和彩超诊断为主。 2.采用双侧子宫动脉栓塞术治疗胎盘植入，，其术前准备时间和手术时间均短，出血控制迅速且并发症少，保留了患者的子宫，提高了患者的生活质量。
[Abstract]:Background and significance: placenta accreta (placenta implantation,PI) belongs to the category of pregnancy-associated hemorrhagic diseases. In order to prevent the potential complications of intractable hemorrhage, uterine artery embolization is a new method to replace surgical procedures, in addition to perinatal hysterectomy. It has been proven to be more than 90% successful in controlling postpartum hemorrhage that does not respond to other treatments. This study analyzed the clinical characteristics of placenta accreta and discussed the clinical effect of uterine artery embolization in the treatment of placenta accreta, its complications and its influence on future fertility. Objective: to investigate the clinical features and diagnostic methods of placenta accreta in our hospital, the curative effect and complication of uterine artery embolization. Methods: 1. Collecting general data: from January 2006 to December 2011, 110 patients with placenta accreta were admitted to our department, including 80 cases of late pregnancy. The patients were divided into three groups according to the treatment method: (1) the conservative treatment group (12 cases) was treated with medicine (mainly mifepristone); 2uterine artery embolization (uterine arteryembolization,UAE) group (n = 40), bilateral uterine artery embolization group (n = 40), hysterectomy group (n = 9), hysterectomy group (n = 9). The patient's age, pregnancy, gestational age, past history, diagnosis and treatment were recorded. 2. Data and indicators observed and recorded: clinical outcomes of the three groups, effective rate of embolization (e.g. reduction or cessation of bleeding, menorrhagia or re-pregnancy) and failure rate (e.g. secondary embolism, hysterectomy or maternal death), The blood loss, blood transfusion, hospital stay, operative time, placental discharge and menstrual resuscitation were compared among the three groups. The follow-up information on menstruation and fertility was obtained by telephone follow-up, and the normal menstrual regurgitation and re-pregnancy were recorded during the 1-year follow-up period. 3. Statistical analysis: statistical software SPSS19.0 was used for statistical analysis. The measurement data were expressed as mean 卤standard deviation (x 卤s), t test or analysis of variance (P < 0. 05). Results: 1. The occurrence of placenta accreta was related to the history of cesarean section (38.18%), uterine curettage (92.73%), placenta previa (32.73%) and age (30.00%). The diagnosis depends on clinical manifestation, color ultrasonography and pathological examination. 2. There was no significant difference in age, gestational age and pregnancy in uterine artery embolization group, hysterectomy group and conservative treatment group (P > 0.05). 3. Successful hemostasis was achieved in 38 cases after transuterine artery embolization, and hysterectomy was performed in 2 cases without hemostasis. There were no serious complications such as organ necrosis and nerve injury after embolization. Fever and lower abdominal pain were common complications. 4. There were significant differences among uterine artery embolism group, hysterectomy group and conservative treatment group in the amount of bleeding and blood transfusion, operation time and hospital stay (P < 0.05). 5. The patients in UAE group were followed up for one year. Except for 9 cases of lost visit, the other patients returned to normal menstruation during the follow-up period, and 2 cases were pregnant again. Conclusion: 1. The incidence of placenta accreta increased with time. The diagnosis of placenta accreta mainly consists of clinical diagnosis and color Doppler ultrasound diagnosis. 2. Using bilateral uterine artery embolization to treat placenta accreta, the preoperative preparation time and operation time are short, bleeding is controlled quickly and complications are less, the uterus of the patient is preserved and the quality of life of the patient is improved.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.2
本文编号：2305712
[Abstract]:Background and significance: placenta accreta (placenta implantation,PI) belongs to the category of pregnancy-associated hemorrhagic diseases. In order to prevent the potential complications of intractable hemorrhage, uterine artery embolization is a new method to replace surgical procedures, in addition to perinatal hysterectomy. It has been proven to be more than 90% successful in controlling postpartum hemorrhage that does not respond to other treatments. This study analyzed the clinical characteristics of placenta accreta and discussed the clinical effect of uterine artery embolization in the treatment of placenta accreta, its complications and its influence on future fertility. Objective: to investigate the clinical features and diagnostic methods of placenta accreta in our hospital, the curative effect and complication of uterine artery embolization. Methods: 1. Collecting general data: from January 2006 to December 2011, 110 patients with placenta accreta were admitted to our department, including 80 cases of late pregnancy. The patients were divided into three groups according to the treatment method: (1) the conservative treatment group (12 cases) was treated with medicine (mainly mifepristone); 2uterine artery embolization (uterine arteryembolization,UAE) group (n = 40), bilateral uterine artery embolization group (n = 40), hysterectomy group (n = 9), hysterectomy group (n = 9). The patient's age, pregnancy, gestational age, past history, diagnosis and treatment were recorded. 2. Data and indicators observed and recorded: clinical outcomes of the three groups, effective rate of embolization (e.g. reduction or cessation of bleeding, menorrhagia or re-pregnancy) and failure rate (e.g. secondary embolism, hysterectomy or maternal death), The blood loss, blood transfusion, hospital stay, operative time, placental discharge and menstrual resuscitation were compared among the three groups. The follow-up information on menstruation and fertility was obtained by telephone follow-up, and the normal menstrual regurgitation and re-pregnancy were recorded during the 1-year follow-up period. 3. Statistical analysis: statistical software SPSS19.0 was used for statistical analysis. The measurement data were expressed as mean 卤standard deviation (x 卤s), t test or analysis of variance (P < 0. 05). Results: 1. The occurrence of placenta accreta was related to the history of cesarean section (38.18%), uterine curettage (92.73%), placenta previa (32.73%) and age (30.00%). The diagnosis depends on clinical manifestation, color ultrasonography and pathological examination. 2. There was no significant difference in age, gestational age and pregnancy in uterine artery embolization group, hysterectomy group and conservative treatment group (P > 0.05). 3. Successful hemostasis was achieved in 38 cases after transuterine artery embolization, and hysterectomy was performed in 2 cases without hemostasis. There were no serious complications such as organ necrosis and nerve injury after embolization. Fever and lower abdominal pain were common complications. 4. There were significant differences among uterine artery embolism group, hysterectomy group and conservative treatment group in the amount of bleeding and blood transfusion, operation time and hospital stay (P < 0.05). 5. The patients in UAE group were followed up for one year. Except for 9 cases of lost visit, the other patients returned to normal menstruation during the follow-up period, and 2 cases were pregnant again. Conclusion: 1. The incidence of placenta accreta increased with time. The diagnosis of placenta accreta mainly consists of clinical diagnosis and color Doppler ultrasound diagnosis. 2. Using bilateral uterine artery embolization to treat placenta accreta, the preoperative preparation time and operation time are short, bleeding is controlled quickly and complications are less, the uterus of the patient is preserved and the quality of life of the patient is improved.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.2
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