發(fā)布時(shí)間：2018-03-06 17:32

  本文選題：剖宮產(chǎn)術(shù)后瘢痕妊娠　切入點(diǎn)：子宮動脈栓塞術(shù)　出處：《新疆醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討子宮動脈栓塞術(shù)聯(lián)合宮腔鏡手術(shù)治療在剖宮產(chǎn)瘢痕妊娠臨床療效及應(yīng)用價(jià)值。方法：回顧性分析新疆醫(yī)科大學(xué)第一附屬醫(yī)院婦科2010年1月至2013年6月間收治的67剖宮產(chǎn)術(shù)后瘢痕妊娠患者的診療過程。根據(jù)患者不同的診療方案：分類A組35例雙側(cè)子宮動脈栓塞術(shù)(UAE)組,B組32例甲氨蝶呤(MTX)肌內(nèi)注射組,兩組均隨后成功施行宮腔鏡電切手術(shù)治療。各組對術(shù)中出血量、住院天數(shù)、術(shù)后血-HCG轉(zhuǎn)陰時(shí)間、月經(jīng)恢復(fù)時(shí)間、病灶消失時(shí)間、成功率等臨床指標(biāo)進(jìn)行比較。結(jié)果：65例患者一次性治療成功。栓塞組和MTX組術(shù)中出血量分別為(32.00±8.06)ml和(71.41±20.7)ml；住院天數(shù)分別為(12.46±5.0)d和(16.16±5.4)d；病灶消失時(shí)間分別為(50.74±22.0)d和(68.44±35.6)d；血-HCG轉(zhuǎn)陰時(shí)間分別為(37.63±12.4)d和(61.25±20.7)d,各指標(biāo)比較具有顯著性差異(P0.05),月經(jīng)恢復(fù)時(shí)間分別為栓塞組(40.80±11.36)d和MTX組(43.38±9.9)d；月經(jīng)恢復(fù)時(shí)間兩組無差異(P0.05)。在MTX組1患者術(shù)后15天因嚴(yán)重陰道流血急診行全子宮切除術(shù)。結(jié)論：對于治療剖宮產(chǎn)術(shù)后瘢痕妊娠經(jīng)子宮動脈栓塞聯(lián)合宮腔鏡下病灶清除術(shù)視為一種安全、有效、首選的治療方法,能明顯減少清宮過程中的出血量、縮短β-HCG值下降至正常的時(shí)間、縮短住院時(shí)間,而且創(chuàng)傷小,成功率高,保留了患者的生育功能,并且不影響患者的生理功能,降低了醫(yī)療風(fēng)險(xiǎn),并其他治療提供機(jī)會。
[Abstract]:Objective: to investigate the clinical effect and value of uterine artery embolization combined with hysteroscopic surgery in the treatment of cesarean scar pregnancy. Methods: the gynecological department of the first affiliated Hospital of Xinjiang Medical University from January 2010 to June 2013 was retrospectively analyzed. The course of diagnosis and treatment of 67 cases of scar pregnancy after cesarean section. According to the different diagnosis and treatment plan: group A (35 cases with bilateral uterine artery embolization) group B and group B (32 cases with MTX) intramuscular injection of methotrexate (MTX) were classified into three groups: group A (35 cases with bilateral uterine artery embolization) and group B (32 cases with intramuscular injection of MTX). The two groups were treated successfully by hysteroscopic electrotomy. The blood loss, hospitalization days, blood-HCG negative time, menstrual recovery time and lesion disappearance time were observed in each group. Results the intraoperative bleeding volume of embolization group and MTX group were 32.00 鹵8.06ml and 71.41 鹵20.7ml, respectively, the days of hospitalization were 12.46 鹵5.0 days and 16.16 鹵5.4 days, the time of lesion disappearance were 50.74 鹵22.0d and 68.44 鹵35.6d, respectively. The time of menorrhagia was 37.63 鹵12.4 days and 61.25 鹵20.7 days, respectively. There was significant difference between the two groups (P 0.05). The recovery time of menstruation was 40.80 鹵11.36 days in the embolization group and 43.38 鹵9.9 days in the MTX group, and there was no difference between the two groups in the recovery time of menstruation (P0.055.The first patient in the MTX group received emergency treatment 15 days after operation due to severe vaginal bleeding). Conclusion: it is safe to treat scar pregnancy after cesarean section by transuterine arterial embolization combined with hysteroscopic debridement. Effective, the first choice treatment method can obviously reduce the amount of blood loss in the process of clearing the uterus, shorten the 尾 -HCG value to the normal time, shorten the hospitalization time, and the trauma is small, the success rate is high, and the patient's fertility function is preserved. And does not affect the patient's physiological function, reduced medical risk, and other treatment opportunities.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R713.4

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