本文關(guān)鍵詞： 子宮破裂 輸卵管間質(zhì)部妊娠 危險(xiǎn)因素 臨床特點(diǎn)　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:輸卵管間質(zhì)部妊娠是異位妊娠的一種特殊類型,目前手術(shù)多采用腹腔鏡下患側(cè)輸卵管及部分宮角切除。同時(shí)越來越多的術(shù)后患者存在生育要求,而間質(zhì)部妊娠術(shù)后患者再次妊娠期間存在子宮破裂風(fēng)險(xiǎn)。因而本文旨在總結(jié)輸卵管間質(zhì)部妊娠術(shù)后再次妊娠期間子宮破裂的患者的臨床特征,從而能夠?yàn)榕R床診治提供參考。方法:回顧性分析我院1999-2016年收治的4例輸卵管間質(zhì)部妊娠術(shù)后再次妊娠期間子宮破裂患者的臨床資料,結(jié)合復(fù)習(xí)相關(guān)文獻(xiàn),探討輸卵管間質(zhì)部妊娠術(shù)后子宮破裂的危險(xiǎn)因素、臨床特點(diǎn)、處理及預(yù)后。結(jié)果:1999年11月至2016年10月我院共有283例子宮破裂患者,其中輸卵管間質(zhì)部妊娠術(shù)后子宮破裂4例。本文報(bào)道的4例患者均為育齡期女性,年齡為28-42歲,既往均有不良孕史,所有患者均曾因輸卵管異位妊娠行單側(cè)或雙側(cè)輸卵管切除史。而4例患者末次妊娠均為輸卵管間質(zhì)部妊娠,并均行腹腔鏡下患側(cè)宮角切除術(shù),僅2例官角切除后進(jìn)行縫合。而此次間質(zhì)部妊娠術(shù)后再次妊娠僅有一例為自然妊娠,其余均為輔助生育妊娠。手術(shù)至再次妊娠時(shí)間間隔,最短為0.52年,最長為2.25年。4例患者分娩孕周最小17周,最大37+1周,其中2例為雙胎妊娠,2例患者存在胎位異常,而4例患者妊娠子宮破裂均在既往宮角瘢痕處。同時(shí)4例妊娠子宮破裂患者中2例均無明顯不適主訴,1例由B超提示,1例由術(shù)中探查發(fā)現(xiàn);1例患者僅有輕微腹痛主訴,一例患者主訴為持續(xù)劇烈腹痛伴惡心腹瀉,于首診時(shí)被誤診為消化道疾病。最終4例患者均僅采取子宮修補(bǔ)術(shù),其中2例胎兒死亡。術(shù)后均順利出院,恢復(fù)可,無月經(jīng)改變,僅有1例患者有再生育要求。結(jié)論:輸卵管間質(zhì)部術(shù)后再次妊娠期間存在子宮破裂的風(fēng)險(xiǎn),在臨床上雖然并不多見,但一旦發(fā)生,其臨床癥狀并不明顯,易誤診漏診,對(duì)母嬰威脅較大。因而對(duì)輸卵管間質(zhì)部妊娠的患者,需選擇合適的治療方式,并注意術(shù)中的操作和術(shù)后的避孕時(shí)間,再次妊娠期間需加強(qiáng)監(jiān)測(cè),警惕子宮破裂風(fēng)險(xiǎn),必要時(shí)行剖官產(chǎn)術(shù)終止妊娠。
[Abstract]:Objective: interstitial tubal pregnancy is a special type of ectopic pregnancy. However, there is a risk of uterine rupture during secondary pregnancy in patients with interstitial pregnancy. Therefore, this article aims to summarize the clinical features of patients with uterine rupture during secondary pregnancy after tubal interstitial pregnancy. Methods: the clinical data of 4 cases of uterine rupture during secondary pregnancy after tubal interstitial pregnancy in our hospital from 1999 to 2016 were analyzed retrospectively. To investigate the risk factors, clinical features, management and prognosis of uterine rupture after tubal interstitial pregnancy. Results: from November 1999 to October 2016, there were 283 cases of uterine rupture in our hospital. There were 4 cases of uterine rupture after tubal interstitial pregnancy. All the patients had undergone unilateral or bilateral salpingotomy because of ectopic tubal pregnancy. Only 2 cases were sutured after keratectomy. However, only one case of secondary pregnancy after interstitial pregnancy was natural pregnancy, and the rest were assisted pregnancy. The interval between operation and re-pregnancy was 0.52 years, the shortest time interval between operation and re-pregnancy was 0.52 years, and the time interval between operation and re-pregnancy was 0.52 years. The longest pregnancy was 2.25 years. The gestational age was 17 weeks and the maximum was 37.1 weeks. Among them, 2 cases were twin pregnancy and 2 cases had abnormal fetal position. However, 4 cases of pregnancy uterine rupture were located in the scar of the previous uterine horn, and 2 of the 4 cases of pregnancy with uterine rupture had no obvious complaints of discomfort, 1 case was revealed by B-ultrasound, 1 case was found to have mild abdominal pain by intraoperative exploration, and 1 case was found to have only mild abdominal pain. One patient complained of persistent severe abdominal pain with nausea and diarrhea, which was misdiagnosed as digestive tract disease at the first visit. In the end, all the 4 patients were treated with uterine repair only, 2 of them died of fetal death. Conclusion: there is a risk of uterine rupture during the second pregnancy after tubal tubal interstitial surgery. Although it is rare in clinic, its clinical symptoms are not obvious, and it is easy to be misdiagnosed and missed. Therefore, the patients with tubal interstitial pregnancy should choose the appropriate treatment method, pay attention to the operation during operation and the time of contraception after operation, strengthen the monitoring during the second pregnancy, and be on guard against the risk of uterine rupture. Termination of pregnancy by dissection if necessary.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R713.8

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王毅,邱林霞;先兆子宮破裂及子宮破裂43例臨床分析[J];安徽醫(yī)學(xué);2000年02期

2 徐學(xué)娟;子宮破裂4例治療體會(huì)[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2000年10期

3 容俊,張春萍;子宮破裂及子宮破裂性損傷39例分析[J];云南醫(yī)藥;2000年02期

4 唐桂蘭,馬桂花;懷柔縣20年子宮破裂68例分析[J];中國婦幼保健;2000年11期

5 李鳳蓮;子宮破裂引起孕產(chǎn)婦死亡6例分析[J];浙江中西醫(yī)結(jié)合雜志;2000年07期

6 劉蓮秋;子宮破裂183例臨床分析[J];中國婦產(chǎn)科臨床;2001年02期

7 聶春梅;子宮破裂1例報(bào)告[J];中國煤炭工業(yè)醫(yī)學(xué)雜志;2001年12期

8 史豐玉,范淑英;子宮破裂34例分析[J];臨床誤診誤治;2002年02期

9 成清奇;子宮破裂18例分析[J];中國誤診學(xué)雜志;2002年09期

10 王永榮;不典型子宮破裂1例報(bào)告[J];山東醫(yī)藥;2003年24期

相關(guān)會(huì)議論文 前10條

1 陳悅悅;劉興會(huì);;子宮破裂的原因和診治——附22例子宮破裂臨床分析[A];2007年中華醫(yī)學(xué)會(huì)—強(qiáng)生西部學(xué)術(shù)講座全國產(chǎn)科危重癥學(xué)術(shù)研討會(huì)論文匯編[C];2007年

2 繆士霞;;援外期間52例子宮破裂的診治[A];中華醫(yī)學(xué)會(huì)急診醫(yī)學(xué)學(xué)會(huì)第六次全國急診醫(yī)學(xué)學(xué)術(shù)會(huì)議論文匯編[C];1996年

3 趙三存;;子宮破裂的防治[A];2007年中華醫(yī)學(xué)會(huì)—強(qiáng)生西部學(xué)術(shù)講座全國產(chǎn)科危重癥學(xué)術(shù)研討會(huì)論文匯編[C];2007年

4 馮良平;黃衛(wèi)華;;子宮破裂36例臨床分析[A];中華醫(yī)學(xué)會(huì)第一屆全球華人婦產(chǎn)科學(xué)術(shù)大會(huì)暨第三次全國婦產(chǎn)科中青年醫(yī)師學(xué)術(shù)會(huì)議論文匯編[C];2007年

5 王清碧;;3例子宮破裂休克的臨床與護(hù)理[A];2001年全國中西醫(yī)結(jié)合急救醫(yī)學(xué)學(xué)術(shù)會(huì)議論文集[C];2001年

6 陳小梅;鄭巧玲;陳莉娜;;26例子宮破裂孕產(chǎn)婦死亡情況分析[A];紀(jì)念卓越的人民醫(yī)學(xué)家林巧稚大夫誕辰100周年——全國婦產(chǎn)科高級(jí)學(xué)術(shù)論壇論文集[C];2001年

7 朱千峰;管雅珍;;違規(guī)操作、用藥致子宮破裂及胎兒死亡一例[A];中國法醫(yī)學(xué)會(huì)法醫(yī)臨床學(xué)學(xué)術(shù)研討會(huì)論文集[C];2002年

8 王會(huì)梅;;縮宮素用量不當(dāng)致子宮破裂一例[A];第三次全國婦產(chǎn)科基層醫(yī)師學(xué)術(shù)會(huì)議資料匯編[C];2005年

9 董耀紅;楊湘妹;;1例子宮破裂合并膀胱破裂術(shù)后的護(hù)理干預(yù)[A];全國婦產(chǎn)科新技術(shù)、新理論進(jìn)展研討會(huì)、全國助產(chǎn)專業(yè)護(hù)士培訓(xùn)班論文匯編[C];2011年

10 董耀紅;楊湘妹;;1例子宮破裂合并膀胱破裂術(shù)后的護(hù)理干預(yù)[A];中華護(hù)理學(xué)會(huì)第8屆全國造口、傷口、失禁護(hù)理學(xué)術(shù)交流會(huì)議、全國外科護(hù)理學(xué)術(shù)交流會(huì)議、全國神經(jīng)內(nèi)、外科護(hù)理學(xué)術(shù)交流會(huì)議論文匯編[C];2011年

相關(guān)重要報(bào)紙文章 前4條

1 韋棟;子宮破裂的臨床表現(xiàn)[N];農(nóng)村醫(yī)藥報(bào)（漢）;2009年

2 王永利;自發(fā)性血管破裂致休克誤診為子宮破裂[N];農(nóng)村醫(yī)藥報(bào)（漢）;2009年

3 山西醫(yī)科大學(xué)第二醫(yī)院婦產(chǎn)科主任 郝敏;如何避免肌瘤剔除后子宮破裂[N];健康報(bào);2012年

4 談?wù)滂?剖腹產(chǎn)后短期內(nèi)不宜懷孕[N];大眾衛(wèi)生報(bào);2004年

相關(guān)博士學(xué)位論文 前1條

1 樸恩誼;中晚孕期子宮破裂的危險(xiǎn)因素及不同處理方案的預(yù)后研究[D];浙江大學(xué);2015年

相關(guān)碩士學(xué)位論文 前1條

1 邵敏佳;疤痕子宮破裂風(fēng)險(xiǎn)因素分析[D];浙江大學(xué);2015年

，

本文編號(hào)：1555495