子宫动脉化疗栓塞术治疗胎盘植入61例的临床分析

发布时间：2019-08-14 08:43

【摘要】：目的:探讨子宫动脉化疗栓塞术治疗胎盘植入的临床疗效及预后。方法:以胎盘植入患者61例为研究对象,按治疗方式不同分为保守治疗组31例和化疗栓塞组30例。保守治疗组仅单纯口服米非司酮治疗,而化疗栓塞组采用子宫动脉化疗栓塞术进行治疗。比较两组患者的临床疗效、手术时间、出血量、输血量、住院时间、胎盘排出和月经复潮时间,术后并发症的发生情况,并随访术后1年患者的月经情况和妊娠情况。结果:经子宫动脉化疗栓塞术后29例成功止血,有1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。而保守治疗组的31例患者中,因治疗失败导致切除子宫的7例,仅24例有效保留子宫,成功率仅77.4%,严重影响患者以后的生育能力。6例发生宫腔感染,4例发生宫腔粘连。子宫动脉化疗栓塞组β-HCG恢复正常时间、输血量、胎盘完全清除时间、月经异常的发生情况均优于保守治疗组,差异有统计学意义(P0.05)。对子宫动脉化疗栓塞术组患者进行为期1年的随访,14例患者在术后1个月后有胎盘组织自阴道排出,有11例患者2个月后发现胎盘残留,予以清宫术,除3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:采用子宫动脉化疗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,有助于保留患者的子宫,提高患者的生活质量。
[Abstract]:Objective: to investigate the clinical effect and prognosis of uterine artery chemoembolization in the treatment of placental implantation. Methods: 61 patients with placental implantation were divided into conservative treatment group (n = 31) and chemoembolism group (n = 30). The conservative treatment group was treated with mifepristone alone, while the chemoembolism group was treated with uterine artery chemoembolism. The clinical efficacy, operation time, bleeding volume, blood transfusion volume, hospitalization time, placental excretion and menstruation time, postoperative complications were compared between the two groups, and the menstruation and pregnancy were followed up one year after operation. Results: 29 cases were successfully hemostatic and 1 case failed to stop bleeding after transuterine artery chemoembolization. There were no serious complications, such as local ischemic necrosis, nerve injury, fever and lower abdominal pain. In the conservative treatment group, 7 cases were resected because of the failure of treatment, only 24 cases effectively preserved the uterus, the success rate was only 77.4%, which seriously affected the fertility of the patients in the future. 6 cases had uterine cavity infection and 4 cases had uterine cavity adhesion. The recovery time of 尾-HCG, the amount of blood transfusion, the time of complete placental clearance and the occurrence of abnormal menstruation in uterine artery chemoembolism group were better than those in conservative treatment group, the difference was statistically significant (P 0.05). The patients in the uterine artery chemoembolism group were followed up for one year. 14 patients had placental tissue excreted from vagina one month after operation, and 11 patients found placental residue 2 months later. Except 3 patients lost follow-up, the other patients returned to normal menstruation within the follow-up time, and 2 patients were pregnant again. Conclusion: the preoperative preparation time and operation time are short, the bleeding control is rapid and the complications are few, which is helpful to preserve the uterus and improve the quality of life of the patients with placental implantation.
【作者单位】：南京医科大学附属南京妇幼保健院;
【分类号】：R714.462

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