679例输卵管妊娠治疗方案的临床分析
发布时间：2018-12-17 06:02
【摘要】：背景与目的输卵管妊娠(tubal pregnancy)是指受精卵在输卵管部位着床,它是异位妊娠中最常见的一种,发生率约占95%。输卵管妊娠好发于生育期的女性,是严重威胁育龄期女性生育力和生命的常见病之一。在临床上,输卵管妊娠是一种发病原因不明确,治疗方案并不完全统一的疾病,临床工作者们从未停止过对它的研究。临床中,常通过对女性的血βHCG值和彩超等检查结果来诊断输卵管妊娠。血βHCG是胚胎滋养细胞合成分泌的,可在一定程度上反映滋养细胞的活性。临床上输卵管妊娠的治疗,主要包括药物治疗和手术治疗,药物治疗主要是应用化疗药物甲氨蝶呤来抑制滋养细胞的增生促使胚胎死亡,从而达到治愈;手术治疗主要是通过输卵管妊娠组织的清除或者患侧输卵管的切除,而治愈该种疾病。本研究通过对治疗前血βHCG的变化趋势与治疗结果的分析,从而总结对输卵管妊娠这一疾病的临床治疗经验。材料与方法材料回顾自2012年1月至2016年1月在郑州大学第二附属医院诊治的679例输卵管妊娠的患者的临床资料进行分析。方法统计所有患者的一般资料:年龄、孕次、产次、停经时间、阴道出血时间、住院时间及附件区包块直径的大小、治疗前血βHCG浓度的大小。依据患者采用的治疗方案不同,将679例患者,分为药物治疗组(A组)265例,其中单次化疗方案的为156例,连续化疗方案的为109例;手术治疗组(B组)414例,行保守手术的为272例,根治性手术的为142例;依据患者治疗前血βHCG浓度的变化趋势,分为上升组(1组)285例,下降组(2组)188例。A组中,呈上升趋势的A1组有100例,呈下降趋势的A2组有102例。分析组间的治疗结果。统计学方法应用SPSS17.0处理和分析相关数据,计量资料用均数±标准差及t检验描述,计数资料用卡方检验及单因素方差分析,P0.05为有统计学差异。结果679例患者中,265例行药物保守治疗,414例行手术治疗。1、一般资料在年龄、孕产次、停经时间、阴道出血时间上,A组和B组是无统计学差异的(P0.05);而A组的住院时间长于B组;A组的附件区包块直径小于B组,A组的治疗前血βHCG值小于B组,均有统计学差异。2、病例资料(1)A组中,单次化疗方案和连续化疗方案的治疗成功率分别为87.18%、91.74%,无统计学差异(P0.05);(2)在输卵管妊娠的治疗上,1组的治疗成功率为88.77%,2组为98.79%,有统计学差异(P=0.000.05);A1组与A2组的治疗成功率分别为72.00%,99.02%,有统计学差异(P=0.000.05)。结论1、对于生命体征平稳,治疗前间隔48小时血βHCG呈上升趋势且上升幅度≥5%的患者,药物保守治疗失败率较高;2、对于生命体征平稳,治疗前间隔48小时血βHCG呈下降趋势且下降幅度≥5%的患者,药物保守治疗成功率较高。
[Abstract]:Background & objective (tubal pregnancy) refers to the implantation of fertilized eggs in the oviduct. It is the most common ectopic pregnancy, the incidence of which accounts for 95%. Fallopian tube pregnancy is one of the common diseases that threaten the fertility and life of women of reproductive age. In clinic, tubal pregnancy is a kind of disease which is not clear about the cause and the treatment plan is not completely unified. The clinical workers have never stopped studying it. In clinic, tubal pregnancy is often diagnosed by blood 尾-HCG and color Doppler ultrasound. Serum 尾-HCG is synthesized and secreted by embryonic trophoblast, which can reflect the activity of trophoblast to some extent. The clinical treatment of tubal pregnancy mainly includes drug treatment and surgical treatment. The drug therapy mainly uses chemotherapy drug methotrexate to inhibit the proliferation of trophoblastic cells to promote embryo death and thus to achieve cure. Surgical treatment is mainly through the removal of tubal pregnancy tissue or resection of the affected side of the fallopian tube, and cure the disease. In this study, the clinical experience in the treatment of tubal pregnancy was summarized by analyzing the change trend and treatment results of serum 尾 HCG before treatment. Materials and methods the clinical data of 679 cases of tubal pregnancy treated in the second affiliated Hospital of Zhengzhou University from January 2012 to January 2016 were analyzed. Methods the general data of all patients were analyzed: age, pregnancy, labor, menopause time, vaginal bleeding time, hospitalization time, diameter of adnexal mass, and serum 尾 HCG concentration before treatment. According to the different treatment regimen, 679 patients were divided into two groups: group A (n = 265), single chemotherapy regimen (n = 156) and continuous chemotherapy regimen (n = 109). There were 414 cases in group B, 272 cases underwent conservative operation and 142 cases underwent radical operation. According to the change trend of serum 尾 HCG before treatment, 285 patients were divided into two groups: group 1 (n = 285) and group A (n = 188). In group A, there were 100 cases in A 1 group and 102 cases in A 2 group. The results of treatment between groups were analyzed. Statistical methods were used to process and analyze the relevant data by SPSS17.0, the measurement data were described by mean 卤standard deviation and t test, and the counting data were described by chi-square test and single factor analysis of variance (P0.05). Results among 679 patients, 265 cases received conservative drug therapy and 414 cases underwent surgical treatment. 1. There was no significant difference in age, pregnancy and delivery, menopause time and vaginal bleeding time between group A and group B (P0.05). The length of hospitalization in group A was longer than that in group B; The diameter of adnexal mass in group A was smaller than that in group B, and the serum 尾 HCG value of group A was smaller than that of group B (P < 0.05). There was statistical difference between group A and group A. the success rates of single chemotherapy regimen and continuous chemotherapy regimen were 87.18 in group A, respectively. 91.74, there was no statistical difference (P0.05); (2) in the treatment of tubal pregnancy, the success rate of treatment in group 1 was 88.777.The success rate of group 2 was 98.79 (P < 0.000.05). The successful rate of treatment in group A1 and group A2 was 72.00 and 99.02, respectively (P < 0.000.05). Conclusion (1) for patients with stable vital signs and 48 hours before treatment, the failure rate of conservative drug therapy was higher than that of patients whose serum 尾 HCG increased by more than 5% at the interval of 48 hours before treatment. 2. The success rate of conservative treatment was higher in patients with stable vital signs and decreased serum 尾 HCG at 48 hours before treatment and the extent of decline was more than 5%.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.22
本文编号：2383776
[Abstract]:Background & objective (tubal pregnancy) refers to the implantation of fertilized eggs in the oviduct. It is the most common ectopic pregnancy, the incidence of which accounts for 95%. Fallopian tube pregnancy is one of the common diseases that threaten the fertility and life of women of reproductive age. In clinic, tubal pregnancy is a kind of disease which is not clear about the cause and the treatment plan is not completely unified. The clinical workers have never stopped studying it. In clinic, tubal pregnancy is often diagnosed by blood 尾-HCG and color Doppler ultrasound. Serum 尾-HCG is synthesized and secreted by embryonic trophoblast, which can reflect the activity of trophoblast to some extent. The clinical treatment of tubal pregnancy mainly includes drug treatment and surgical treatment. The drug therapy mainly uses chemotherapy drug methotrexate to inhibit the proliferation of trophoblastic cells to promote embryo death and thus to achieve cure. Surgical treatment is mainly through the removal of tubal pregnancy tissue or resection of the affected side of the fallopian tube, and cure the disease. In this study, the clinical experience in the treatment of tubal pregnancy was summarized by analyzing the change trend and treatment results of serum 尾 HCG before treatment. Materials and methods the clinical data of 679 cases of tubal pregnancy treated in the second affiliated Hospital of Zhengzhou University from January 2012 to January 2016 were analyzed. Methods the general data of all patients were analyzed: age, pregnancy, labor, menopause time, vaginal bleeding time, hospitalization time, diameter of adnexal mass, and serum 尾 HCG concentration before treatment. According to the different treatment regimen, 679 patients were divided into two groups: group A (n = 265), single chemotherapy regimen (n = 156) and continuous chemotherapy regimen (n = 109). There were 414 cases in group B, 272 cases underwent conservative operation and 142 cases underwent radical operation. According to the change trend of serum 尾 HCG before treatment, 285 patients were divided into two groups: group 1 (n = 285) and group A (n = 188). In group A, there were 100 cases in A 1 group and 102 cases in A 2 group. The results of treatment between groups were analyzed. Statistical methods were used to process and analyze the relevant data by SPSS17.0, the measurement data were described by mean 卤standard deviation and t test, and the counting data were described by chi-square test and single factor analysis of variance (P0.05). Results among 679 patients, 265 cases received conservative drug therapy and 414 cases underwent surgical treatment. 1. There was no significant difference in age, pregnancy and delivery, menopause time and vaginal bleeding time between group A and group B (P0.05). The length of hospitalization in group A was longer than that in group B; The diameter of adnexal mass in group A was smaller than that in group B, and the serum 尾 HCG value of group A was smaller than that of group B (P < 0.05). There was statistical difference between group A and group A. the success rates of single chemotherapy regimen and continuous chemotherapy regimen were 87.18 in group A, respectively. 91.74, there was no statistical difference (P0.05); (2) in the treatment of tubal pregnancy, the success rate of treatment in group 1 was 88.777.The success rate of group 2 was 98.79 (P < 0.000.05). The successful rate of treatment in group A1 and group A2 was 72.00 and 99.02, respectively (P < 0.000.05). Conclusion (1) for patients with stable vital signs and 48 hours before treatment, the failure rate of conservative drug therapy was higher than that of patients whose serum 尾 HCG increased by more than 5% at the interval of 48 hours before treatment. 2. The success rate of conservative treatment was higher in patients with stable vital signs and decreased serum 尾 HCG at 48 hours before treatment and the extent of decline was more than 5%.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.22
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