發(fā)布時間：2018-02-01 06:48

  本文關鍵詞： 剖宮產后子宮瘢痕妊娠 超聲分型 子宮動脈化療栓塞術 腹腔鏡 陰式手術　出處：《實用婦產科雜志》2017年07期 　論文類型：期刊論文

【摘要】：目的:探討剖宮產瘢痕部位妊娠(CSP)的超聲分型及其對指導臨床治療的意義。方法:回顧性分析成都市第三人民醫(yī)院2013年1月至2016年1月初診收治的CSP 41例的臨床資料,均根據Godin等提出的CSP B超影像診斷標準,結合剖宮產病史明確診斷。在Vial等的超聲分型標準基礎上超聲測量孕囊處子宮肌層厚度,將其分為Ⅰ型組和Ⅱ型組。Ⅰ型組采用甲氨蝶呤(MTX)肌內注射治療,3天后B超引導下清宮術;Ⅱ型組采用雙側子宮動脈化療栓塞術(UACE)后B超引導下清宮術,或UACE后經腹或經腹腔鏡或經陰式手術即病灶切除+子宮修補術。結果:Ⅱ型組與Ⅰ型組相比,孕囊處子宮肌層薄(Ⅰ型3.7±0.6 mm vsⅡ型2.1±1.1 mm),人工流產次數多(Ⅰ型1.5±0.6次vsⅡ型2.8±0.7次),差異均有統(tǒng)計學意義(P0.05)。兩組年齡、停經天數、剖宮產次數間的比較差異無統(tǒng)計學意義(P0.05)。兩組均治療成功,術中出血、術前血β-HCG水平及術后恢復正常時間比較差異無統(tǒng)計學意義(P0.05)。住院時間(Ⅰ型4.7±2.5天vsⅡ型8.6±2.7天)、費用(Ⅰ型5234.6±1688.8元vsⅡ型15668.4±4623.4元)Ⅱ型組均多于Ⅰ型組,差異均有統(tǒng)計學意義(P0.05)。結論:根據CSP超聲分型選擇治療方案針對性強,效果可靠,預后良好。術前應用UACE能有效控制術中出血,是CSP預處理治療有效手段,因其費用較高,選擇性使用于Ⅱ型CSP,性價比高。MTX肌內注射用于Ⅰ型CSP清宮術前,效果可靠,性價比高。
[Abstract]:Objective: To investigate the effect of cesarean scar pregnancy (CSP) type of ultrasound and its significance in guiding clinical treatment. Methods: a retrospective analysis of Third People's Hospital of Chengdu city from January 2013 to early January 2016 from the CSP diagnosis of the clinical data of 41 cases, according to the standard CSP ultrasound imaging diagnosis proposed by Godin et al. Combined with cesarean section in the history of diagnosis. Ultrasound Vial classification based on ultrasonic measurement of gestational sac at the uterine muscle thickness, which can be divided into type I and type II group group. Type I group was treated with methotrexate (MTX) intramuscular injection 3 days after treatment, ultrasound guided curettage; type II group were treated with bilateral uterine artery chemoembolization (UACE) after ultrasound guided curettage, or UACE after transabdominal or transvaginal or laparoscopic surgery excision and repair of the uterus. Results: compared with group II type 1 group, gestational sac myometrium at thin (type I 3.7 + 0.6 mm 2.1 + 1.1 vs type II mm),浜哄伐嫻佷駭嬈℃暟澶，

本文編號：1481225