本文關(guān)鍵詞： 剖宮產(chǎn)后子宮瘢痕妊娠 超聲分型 子宮動(dòng)脈化療栓塞術(shù) 腹腔鏡 陰式手術(shù)　出處：《實(shí)用婦產(chǎn)科雜志》2017年07期 　論文類型：期刊論文

【摘要】：目的:探討剖宮產(chǎn)瘢痕部位妊娠(CSP)的超聲分型及其對(duì)指導(dǎo)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(jù)Godin等提出的CSP B超影像診斷標(biāo)準(zhǔn),結(jié)合剖宮產(chǎn)病史明確診斷。在Vial等的超聲分型標(biāo)準(zhǔn)基礎(chǔ)上超聲測(cè)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(nèi)注射治療,3天后B超引導(dǎo)下清宮術(shù);Ⅱ型組采用雙側(cè)子宮動(dòng)脈化療栓塞術(shù)(UACE)后B超引導(dǎo)下清宮術(shù),或UACE后經(jīng)腹或經(jīng)腹腔鏡或經(jīng)陰式手術(shù)即病灶切除+子宮修補(bǔ)術(shù)。結(jié)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(chǎn)次數(shù)多(Ⅰ型1.5±0.6次vsⅡ型2.8±0.7次),差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組年齡、停經(jīng)天數(shù)、剖宮產(chǎn)次數(shù)間的比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組均治療成功,術(shù)中出血、術(shù)前血β-HCG水平及術(shù)后恢復(fù)正常時(shí)間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。住院時(shí)間(Ⅰ型4.7±2.5天vsⅡ型8.6±2.7天)、費(fèi)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(jì)學(xué)意義(P0.05)。結(jié)論:根據(jù)CSP超聲分型選擇治療方案針對(duì)性強(qiáng),效果可靠,預(yù)后良好。術(shù)前應(yīng)用UACE能有效控制術(shù)中出血,是CSP預(yù)處理治療有效手段,因其費(fèi)用較高,選擇性使用于Ⅱ型CSP,性價(jià)比高。MTX肌內(nèi)注射用于Ⅰ型CSP清宮術(shù)前,效果可靠,性價(jià)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(hào)：1481225