药物流产后阴道流血处理方式的探讨

发布时间：2018-12-08 15:42

【摘要】：研究背景：药物流产是指使用药物为主终止早期妊娠的计划外妊娠补救措施,此法痛苦小、安全、简便、不良反应少,并可避免负压吸宫流产术带来的风险。米非司酮配伍米索前列醇用于药物流产,已在临床普遍应用,完全流产率可达90%-95%。但是,仍有5%-10%的患者因药物流产不全而出现不规则阴道流血,以往对这部分患者大多行清宫术,这不但加重患者的经济负担,而且会增加流产后不孕、月经失调、感染、宫腔粘连等一系列并发症的风险,对于部分患者存在过度治疗的问题；况且,清宫术应用的指征目前也缺乏可靠地循证医学依据。因此,对药物流产后不规则阴道流血的处理是长期以来困扰计划生育工作者的棘手问题,也是限制药物流产临床广泛应用的关键因素,亟待解决。研究目的：探讨药物流产后阴道流血的临床处理方式。研究方法：收集自2010年4月至2011年12月期间因药物流产绒毛排出2周后仍有阴道出血来我院计划生育门诊就诊的患者62例,给予妇科检查、妇科超声检查、血β-hCG检测、宫内清出组织常规病理检查。结果：①超声检查结果：59/62例患者超声检查宫内探及不均质光团,最小径线为0.65cm,最大径线为4.05cm,平均值1.44±0.79cm；3/62例患者超声检查宫内未探及不均质光团。②血β-hCG检测结果：58/62例患者血β-hCG检测高于正常值,最低值27.48mIU/L最高值为3577.11mIU/L,均值699.74.±125.06mIU/L,4/62例患者血β-hCG检测结果正常。③病理检查结果：50/62例患者查见胎盘绒毛占80.65%；9/62例患者查见蜕膜组织,占14.51%；2/62例患者为增生期子宫内膜伴息肉样改变,占3.23%；1/62例患者为增生期子宫内膜,占1.61%。结论：①本研究发现：药物流产后阴道流血的患者95.16%是由于绒毛或蜕膜组织残留引起。②药物流产绒毛排出后阴道流血超过14天(平均28天)、超声检查宫腔内探及不均质光团或血β-hCG水平高于正常均可以考虑清宫。
[Abstract]:Background: drug abortion is an unplanned pregnancy remedy that uses drugs to terminate early pregnancy. It has the advantages of less pain, safety, simplicity, less adverse reactions, and can avoid the risk of negative pressure uterine abortion. Mifepristone combined with misoprostol has been widely used in clinical practice. The complete abortion rate can reach 90-95. However, there are still 5- 10% of the patients who have irregular vaginal bleeding due to incomplete medical abortion. In the past, most of these patients were treated with uterine cleaning, which not only increased the economic burden of the patients, but also increased infertility after abortion and menstrual disorders. Infection, intrauterine adhesions and other complications of a series of risks, for some patients with over-treatment problems; Moreover, the indication of the application of Qing Gong surgery is also lack of reliable evidence-based medicine basis at present. Therefore, the treatment of irregular vaginal bleeding after drug abortion is a thorny problem for family planning workers for a long time, and also a key factor to limit the wide application of drug abortion. Objective: to explore the clinical management of vaginal bleeding after drug abortion. Methods: from April 2010 to December 2011, 62 patients who still had vaginal bleeding in our family planning clinic from April 2010 to December 2011 were given gynecological examination, gynecological ultrasound examination and blood 尾-hCG test. Routine pathological examination of intrauterine clear tissue. Results: (1) Ultrasonography: in 59 / 62 patients, intrauterine uneven light masses were examined by ultrasound, the minimum diameter was 0.65 cm, the maximum diameter was 4.05 cm, the average value was 1.44 卤0.79 cm; 3 / 62 patients were examined by ultrasound. 2 results of blood 尾-hCG: the detection of 尾-hCG in 58 / 62 patients was higher than the normal value, the lowest 27.48mIU/L was 3 577.11mIUL, the highest value was 3577.11mIUL, the highest value was 3577.11mIUL. The mean value was 699.74. 卤125.06mIUL / L / 4 / 62 patients' blood 尾-hCG was normal. 3 pathological results: 50 / 62 patients found that placental villi accounted for 80.65%; Decidual tissue was found in 9 / 62 cases, accounting for 14.51% and 62 cases with proliferative endometrium with polyp like changes, 3.23 / 62 cases with proliferative endometrium and 1.61g / 62 cases with proliferative endometrium. Conclusion: 1 in this study, we found that 95.16% of the patients with vaginal bleeding after drug abortion were caused by residual villi or decidua. Ultrasound examination of intrauterine uneven light masses or blood 尾-hCG levels higher than the normal can be considered to clear the uterus.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R169.42

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