本文選題：異位妊娠　切入點(diǎn)：診斷　出處：《鄭州大學(xué)》2014年碩士論文

【摘要】：背景和目的： 異位妊娠(Ectopic Pregnancy, EP)俗稱宮外孕(Extrauterine pregnancy)。是指孕卵著床于子宮體腔以外的部位,可發(fā)生于任何生育期年齡的婦女,是臨床婦產(chǎn)科常見(jiàn)的急腹癥之一。目前EP的發(fā)生率約占妊娠總數(shù)的2%,但病死率約占孕產(chǎn)婦死亡總數(shù)的10%左右。結(jié)合臨床癥狀、超聲及血β-HCG及其它影像學(xué)檢查對(duì)絕大多數(shù)EP早期即可做出明確診斷,因此明確診斷的同時(shí)采取最好的治療方案是目前臨床上治療EP的關(guān)鍵。 分析82例EP的臨床表現(xiàn)、實(shí)驗(yàn)室資料、影像學(xué)表現(xiàn)及介入治療的療效,以探討不同類型的EP的早期臨床表現(xiàn)、影像學(xué)特點(diǎn)及恰當(dāng)?shù)慕槿胫委煼椒?尋求早期診斷和提高療效的新途徑。 材料和方法： 收集2009年12月至2013年3月間,鄭州市婦幼保健院和鄭州市第一人民醫(yī)院的82例異位妊娠患者的臨床、實(shí)驗(yàn)室、病理、影像及介入治療資料。年齡18-38歲,停經(jīng)天數(shù)37-50天,其中輸卵管妊娠52例,宮頸妊娠10例,子宮瘢痕切口妊娠20例。進(jìn)行子宮動(dòng)脈藥物灌注及栓塞術(shù)治療,腹腔鏡手術(shù)治療和輸卵管碘油造影術(shù)檢查。 臨床癥狀主要是停經(jīng)、腹痛和陰道流血,血β-HCG值明顯升高。 子宮動(dòng)脈藥物灌注及栓塞術(shù),采用Seldinger技術(shù)穿刺右側(cè)股動(dòng)脈,再超選子宮動(dòng)脈灌注藥物及明膠海綿栓塞,直至子宮動(dòng)脈主干遠(yuǎn)端栓塞造影呈“截?cái)嗾鳌薄?結(jié)合影像資料根據(jù)胚囊所在的位分為輸卵管妊娠(tubal pregnancy)、卵巢妊娠(ovarian pregnancy)、腹腔妊娠(abdominal pregnancy)、闊韌帶妊娠(broad ligament pregnancy)、宮頸妊娠(cervical pregnancy)、鐕子宮殘角妊娠(pregnancy in rudimentary horn)及近年來(lái)愈來(lái)愈多的剖腹產(chǎn)后所致的瘢痕妊娠(caesarean scarpregnancy, CSP)等。其中輸卵管妊娠最常見(jiàn),約占整個(gè)異位妊娠的95%。臨床表現(xiàn)分析： 收集患者的主要臨床癥狀、初始癥狀、初始癥狀的組間分布情況、生育史及生育方式。實(shí)驗(yàn)室資料研究分析： 分別于術(shù)前1天、術(shù)后1天、2天或3天及二周內(nèi)清晨空腹抽取靜脈血3m1進(jìn)行血值β-HCG檢測(cè),對(duì)不同時(shí)期的β-HCG值變化進(jìn)行分析。影像學(xué)資料分析： 影像分析采用雙盲法。由2位有經(jīng)驗(yàn)的影像科醫(yī)師分別進(jìn)行分析。結(jié)果一致的作為診斷結(jié)果,對(duì)有爭(zhēng)議的結(jié)果再由第三位影像科醫(yī)生觀察、分析,結(jié)果與以前的相對(duì)照,一致的作為診斷和測(cè)量結(jié)果,以保證結(jié)果的準(zhǔn)確、可靠。影像分析包括：①胚囊的位置；②胚囊的大小、有無(wú)胚芽及胎心搏動(dòng)；③胚囊周圍的情況；④盆腔內(nèi)有無(wú)積液。治療分析： 治療方法包括：①子宮動(dòng)脈藥物灌注及栓塞術(shù)治療,②腹腔鏡手術(shù)治療,分析并研究組間治療方法以及術(shù)后療效、術(shù)后并發(fā)癥發(fā)生率、住院時(shí)間關(guān)系。介入術(shù)后療效分析以及術(shù)前、術(shù)后血β-HCG的變化及術(shù)中出血量多少的評(píng)價(jià)。 數(shù)據(jù)處理由SPSS13.0統(tǒng)計(jì)軟件包完成。年齡、癥狀出現(xiàn)的天數(shù)、血β-HCG測(cè)定值及各數(shù)據(jù)以均數(shù)±標(biāo)準(zhǔn)差表示,組間平均值的比較采用獨(dú)立樣本的t檢驗(yàn)或配對(duì)樣本的t檢驗(yàn),組間發(fā)生率的比較采用x2檢驗(yàn)或Fisher's精確概率檢驗(yàn)；計(jì)數(shù)資料以率(%)表示,組間血β-HCG的術(shù)前、術(shù)后測(cè)定數(shù)據(jù)采用重復(fù)測(cè)量設(shè)計(jì)的方差分析以檢驗(yàn)不同水平間差異是否有統(tǒng)計(jì)學(xué)意義；各組數(shù)據(jù)的差別以p0.05具有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 1.大多數(shù)患者是以停經(jīng)、不規(guī)則陰道出血和腹痛為初始癥狀的,而流產(chǎn)史和剖宮產(chǎn)史在異位妊娠中所占的比例也很高。流產(chǎn)史占85.4%,剖宮產(chǎn)史占43.9%。 2.經(jīng)陰道彩色多普勒超聲檢查在對(duì)輸卵管妊娠診斷.比經(jīng)腹部彩色多普勒超聲檢查診斷率明顯提高。 3.52例輸卵管妊娠隨機(jī)分成兩組,一組行腹腔鏡下手術(shù)治療(A組),一組行介入手術(shù)治療(B組)。兩組患者年齡、停經(jīng)時(shí)間、治療前血β-HCG值及異位妊娠包塊最大直徑比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者的術(shù)后常見(jiàn)并發(fā)癥并無(wú)明顯差異。兩組患者的術(shù)后輸卵管再通率有明顯差異,介入手術(shù)治療后比腹腔鏡手術(shù)治療后輸卵管再通率明顯提高。 4.子宮切口妊娠患者本組20例中,所有病例均在7周前確診,年齡主要集中在25-35歲之間的最佳生育年齡階段,本組占18例,占80%。 5.10例不同部位異位妊娠子宮動(dòng)脈介入治療后2-3天血β-HCG值較術(shù)前明顯下降。 6.7例特殊部位異位妊娠子宮動(dòng)脈介入治療后擇期清宮出血量明顯減少。 7.對(duì)于子宮切口妊娠和宮頸妊娠,介入治療比腹腔鏡治療條件范圍更廣,術(shù)中出血量少,且能最大限度的保留正常的生理結(jié)構(gòu)。
[Abstract]:Background and purpose:
Ectopic pregnancy (Ectopic Pregnancy EP) commonly known as ectopic pregnancy (Extrauterine pregnancy). Refer to the antiimplantation in the uterine cavity outside parts, can occur in any reproductive age women, is one of the common clinical acute abdomen of Obstetrics and gynecology. The incidence of EP in pregnancy accounted for about 2% of the total, but the mortality rate is about accounted for about 10% of the total maternal death. Combined with clinical symptoms, ultrasound and serum -HCG and other imaging examination to make most of the early EP can be diagnosed at the same time, so the diagnosis of take the best treatment plan is the key to the current clinical treatment of EP.
Objective to analyze the clinical manifestations, laboratory data, imaging findings and interventional treatment effect of 82 cases of EP, so as to explore the early clinical manifestations, imaging features and appropriate interventional treatment of different types of EP, so as to find a new way to early diagnose and improve curative effect.
Materials and methods:
From December 2009 to March 2013, the MCH Hospital of Zhengzhou city and Zhengzhou city first people's Hospital of 82 cases of ectopic pregnancy in patients with clinical, laboratory, pathological, imaging and interventional therapy. 18-38 years of age, menopause in 37-50 days, of which 52 cases of tubal pregnancy, 10 cases of cervical pregnancy, 20 cases of uterine scar pregnancy incision. Uterine artery drug perfusion and embolization treatment, laparoscopy and hysterosalpingography were examined.
The main clinical symptoms were menopause, abdominal pain and vaginal bleeding, and the value of blood beta -HCG was significantly increased.
Uterine artery infusion and embolization were performed with Seldinger technique to puncture the right femoral artery, and then superselective uterine artery infusion and gelatin sponge embolization until the main artery of uterine artery was embolized.
Combined with the image data according to the embryo sac were divided into tubal pregnancy (tubal pregnancy), ovarian pregnancy (ovarian pregnancy), abdominal pregnancy (abdominal pregnancy), broad ligament pregnancy (broad ligament pregnancy), cervical pregnancy (cervical pregnancy), Zan pregnancy in rudimentary horn (pregnancy in rudimentary horn) and the scar in recent years more and more the caesarean section caused by pregnancy (caesarean scarpregnancy, CSP). The tubal pregnancy is the most common, accounting for 95%. analysis of clinical manifestations of the ectopic pregnancy:
The main clinical symptoms, initial symptoms, the distribution of the initial symptoms, the history of birth and the way of birth were collected, and the laboratory data were studied and analyzed.
Blood samples were collected from 1 days, 1 days, 2 days, 3 days, and two weeks before operation, and the venous blood 3M1 was collected at the early morning, and the blood -HCG was detected. The change of beta -HCG in different periods was analyzed.
Double blind was used in image analysis. By 2 experienced radiologists were analyzed. Results the same as the diagnostic results for controversial results by the third imaging doctors observation, analysis, compared with previous results, the same as the diagnosis and measurement results, to ensure accurate results. Reliable. Image analysis includes: the position of the embryo sac; embryo sac size, there is no embryo and fetal heart beat; the embryo sac around the case; the pelvic effusion treatment analysis:
The treatment methods included: uterine artery infusion and embolization, the laparoscopic surgery, analysis and treatment study group between the method and the curative effect after operation, the incidence of postoperative complications and hospitalization time. After intervention therapy and analysis of preoperative and postoperative changes of serum beta -HCG in postoperative evaluation of how much blood.
The data processed by SPSS13.0 statistical software. The age, number of symptoms, and the data expressed as the mean + SD. Determination of serum beta -HCG, the average value of the groups were compared using t test or paired samples of independent samples t test was used to compare groups, the incidence of x2 test or Fisher's exact probability test; count data to rate (%) said that the group of blood beta -HCG before operation. The data were analyzed by analysis of variance of repeated measurement design to test whether there is difference between different levels of statistical significance after determination; each data difference in P0.05 with statistical significance.
Result錛，

本文編號(hào)：1673785