本文選題：超聲監(jiān)視下清宮術(shù)　切入點(diǎn)：孕囊型剖宮產(chǎn)術(shù)后子宮瘢痕妊娠　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:超聲監(jiān)視下清宮術(shù)是剖宮產(chǎn)術(shù)后子宮瘢痕妊娠(cesarean scar pregnancy,CSP)治療中最常用的一種手術(shù)方法,其具有操作簡(jiǎn)單,費(fèi)用低,損傷小,恢復(fù)快等優(yōu)點(diǎn)。通過(guò)分析291例以超聲監(jiān)視下清宮術(shù)作為初始治療方法的孕囊型CSP患者的不同臨床結(jié)局,探討超聲監(jiān)視下清宮術(shù)失敗的相關(guān)因素以及失敗后宮腔填塞壓迫止血再失敗的相關(guān)因素,旨在總結(jié)孕囊型CSP的處理經(jīng)驗(yàn)。方法:1回顧性分析2006年7月至2016年7月間于河北醫(yī)科大學(xué)第二醫(yī)院婦科行超聲監(jiān)視下清宮術(shù)治療的291例孕囊型CSP患者的病歷資料。2清宮術(shù)中發(fā)生子宮出血并且需要進(jìn)一步治療的為清宮失敗組,無(wú)子宮出血和子宮出血不需要進(jìn)一步治療的為清宮成功組;清宮失敗組中宮腔填塞壓迫止血無(wú)效而行子宮動(dòng)脈栓塞術(shù)的為宮腔填塞壓迫失敗組,有效的為宮腔填塞壓迫成功組。3應(yīng)用卡方檢驗(yàn),Fisher精確概率法及Logistic回歸模型分析清宮失敗和宮腔填塞壓迫止血失敗的相關(guān)因素。結(jié)果:1超聲監(jiān)視下清宮術(shù)作為孕囊型CSP的初始治療方法,清宮成功率為84.2%(245/291),失敗率為15.8%(46/291)。46例超聲監(jiān)視下清宮失敗的孕囊型CSP患者,宮腔填塞壓迫止血成功率為71.7%(33/46),28.3%(13/46)患者因?qū)m腔填塞壓迫止血失敗而行子宮動(dòng)脈栓塞術(shù),血止后行子宮瘢痕妊娠病灶切除+瘢痕子宮修補(bǔ)術(shù)。2超聲監(jiān)視下清宮術(shù)成功組與失敗組病歷資料對(duì)比,統(tǒng)計(jì)分析結(jié)果示:術(shù)前血HCG水平,心管搏動(dòng),頭臀長(zhǎng),孕囊最大徑線,超聲分型,瘢痕肌層厚度及血流分級(jí)差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。表明越高的術(shù)前血HCG水平,孕囊有心管搏動(dòng),越長(zhǎng)的頭臀長(zhǎng),孕囊最大徑線≥3cm,超聲分型中Ⅲ型,瘢痕肌層厚度≤3mm,越豐富的血流與清宮失敗有關(guān)。差異有統(tǒng)計(jì)學(xué)意義的變量構(gòu)建Logistic回歸模型進(jìn)行多變量回歸分析示:超聲監(jiān)視下清宮術(shù)失敗的危險(xiǎn)因素是超聲分型(OR 7.773,95%CI3.038-19.885),頭臀長(zhǎng)(OR 5.561,95%CI 2.974-10.400),血流分級(jí)(OR2.420,95%CI 1.400-4.183),術(shù)前血HCG水平(OR 1.914,95%CI1.113-3.293)。3超聲監(jiān)視下清宮術(shù)失敗組中,宮腔填塞壓迫成功組與失敗組(行子宮動(dòng)脈栓塞+子宮瘢痕妊娠病灶切除+瘢痕子宮修補(bǔ)術(shù))的病歷資料對(duì)比,統(tǒng)計(jì)分析結(jié)果示:術(shù)前血HCG水平,頭臀長(zhǎng),血流分級(jí)差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。表明術(shù)前血HCG值30000m IU/m L,頭臀長(zhǎng)14mm,越豐富的血流與宮腔填塞壓迫止血失敗有關(guān)。差異有統(tǒng)計(jì)學(xué)意義的變量構(gòu)建Logistic回歸模型進(jìn)行多變量回歸分析示:宮腔填塞壓迫止血失敗的危險(xiǎn)因素是血流分級(jí)(OR 19.738,95%CI2.596-150.058)。結(jié)論:1超聲監(jiān)視下清宮術(shù)治療Ⅰ型孕囊型CSP成功率較高。2超聲分型中Ⅲ型,頭臀長(zhǎng)越長(zhǎng),孕囊及其周圍血流越豐富,術(shù)前血HCG水平越高,清宮失敗的可能性越大。3超聲監(jiān)視下清宮術(shù)失敗后,孕囊及其周圍血流越豐富,宮腔填塞壓迫止血失敗的風(fēng)險(xiǎn)相對(duì)較高,子宮動(dòng)脈栓塞術(shù)是較合適的選擇。
[Abstract]:Objective: Ultrasonography is one of the most commonly used procedures in the treatment of uterine scar pregnancy after cesarean section, which has the advantages of simple operation, low cost and little injury. By analyzing the different clinical outcomes of 291 cases of gestational sac type CSP treated with ultrasound monitoring hysteroscopy as the initial treatment, To investigate the factors related to the failure of uterine cavity tamponade under ultrasound monitoring and the factors related to the failure of uterine cavity packing and compression to stop bleeding. To summarize the experience in the management of gestational sac type CSP. Methods: a retrospective analysis of 291 cases of pregnant women with CSP treated by ultrasonography during July 2006 to July 2016 in the second Hospital of Hebei Medical University was carried out in the department of gynecology of the second Hospital of Hebei Medical University. (2) uterine bleeding during the clearance of the uterus and the need for further treatment are in the failed group, The successful group without uterine bleeding and uterine bleeding need no further treatment; the group with uterine cavity tamponade and hemostasis and uterine artery embolization with uterine artery embolization are the failed group of uterine cavity tamponade and compression. In the successful group of intrauterine tamponade and compression, using chi-square test, Fisher accurate probability method and Logistic regression model were used to analyze the factors related to the failure of uterine clearance and uterine packing and hemostasis. Results under the monitoring of 1: 1 ultrasound, uterine clearance was used as the gestational sac. The initial treatment of CSP, The success rate of clearing the uterus was 84.2 / 245 / 291, and the failure rate was 15.80.46 / 291g / 46 cases of pregnancy sac type CSP patients who failed to clear the uterus under the monitoring of ultrasound, and the success rate of uterine cavity tamping and hemostasis was 71.7% / 46% / 28.3% / 13 / 46) patients underwent uterine artery embolization because of the failure of uterine cavity packing compression and hemostasis. Uterine scar pregnancy focus resection scar uterine repair. 2 comparison of medical records between the successful group and the failed group under ultrasound monitoring. The results showed that: preoperative blood HCG level, cardiac tube pulsation, head and hip length, maximum gestational sac diameter, There were significant differences in the thickness of scar myometrium and blood flow grade in ultrasonic classification (P 0.05). The results showed that the higher the preoperative HCG level, the longer the heart tube pulsation, the longer the length of the head and hip, the greater the diameter of the gestational sac and the greater the diameter of the gestational sac. The thicker the thickness of scar muscle layer 鈮，

本文編號(hào)：1570505