本文選題：剖宮產(chǎn)術(shù)后子宮瘢痕妊娠　切入點(diǎn)：清宮術(shù)　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討內(nèi)生型剖宮產(chǎn)術(shù)后瘢痕妊娠(cesarean scar pregnancy,CSP)的臨床特點(diǎn),比較清宮術(shù)和切開(kāi)取胚術(shù)兩種方法治療內(nèi)生型CSP的臨床療效及結(jié)局,為臨床治療內(nèi)生型子宮瘢痕妊娠提供有價(jià)值的參考。方法:回顧性分析廣西醫(yī)科大學(xué)第一附屬醫(yī)院婦產(chǎn)科2012年7月-2016年10月收治的78例內(nèi)生型CSP患者的臨床資料,根據(jù)治療方法不同,將內(nèi)生型CSP患者分為A組(清宮術(shù)組)47例和B組(切開(kāi)取胚術(shù)組)31例,應(yīng)用spss22.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析處理,比較A、B組的臨床一般資料、術(shù)中出血量、手術(shù)持續(xù)時(shí)間、住院費(fèi)用、住院時(shí)間及術(shù)后隨訪情況等相關(guān)指標(biāo)綜合評(píng)價(jià)兩種治療方法的差異。結(jié)果:所有患者入院均經(jīng)陰道彩色多普勒超聲檢查診斷為CSP,其中有10例(12.2%)術(shù)前為明確孕囊與切口及周?chē)M織關(guān)系而通過(guò)MRI(Magnetic resonance imaging)進(jìn)一步檢查,所有患者術(shù)中肉眼可見(jiàn)絨毛或術(shù)后病理可見(jiàn)絨毛組織,且均符合瘢痕妊娠。內(nèi)生型A、B兩組患者的停經(jīng)時(shí)間、年齡、孕產(chǎn)次、人流次數(shù)、入院時(shí)血人絨毛膜促性腺激素(Human Chorionic Gonadotropin,HCG)水平、剖宮產(chǎn)次數(shù)、距上次剖宮產(chǎn)的間隔時(shí)間、病灶最大直徑大小及病灶與子宮漿膜層的距離差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。A組術(shù)中出血量、手術(shù)持續(xù)時(shí)間及住院費(fèi)用均少于B組(均P0.05),而兩組的住院時(shí)間、血β-HCG值降至正常的時(shí)間及術(shù)后月經(jīng)恢復(fù)正常的時(shí)間的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。內(nèi)生型A、B兩組治療方法的成功率比較無(wú)統(tǒng)計(jì)學(xué)差異(χ2=0.009,P=0.925)。結(jié)論:在內(nèi)生型CSP治療上,B超引導(dǎo)下清宮術(shù)與切開(kāi)取胚術(shù)相比,可能更加安全、簡(jiǎn)單、經(jīng)濟(jì)。
[Abstract]:Objective: To investigate the endogenous type of cesarean scar pregnancy (cesarean scar, pregnancy, CSP) the clinical characteristics, clinical efficacy and outcomes of uterine curettage and embryo surgery incision of two methods in the treatment of endogenous CSP, for the treatment of endogenous type of uterine scar pregnancy to provide valuable reference. Methods: a review analysis of the clinical data of 78 cases of endogenous CSP patients in Department of Obstetrics and Gynecology the First Affiliated Hospital of Guangxi Medical University in July 2012 -2016 year in October, according to the different treatment methods, the endogenous CSP were divided into group A (curettage group) 47 cases and group B (incision embryo surgery group) 31 cases, using spss22.0 statistical software analyze the data of A, the general clinical data of B group, the amount of bleeding, hospitalization expenses, duration of operation, the difference between the two treatment methods of comprehensive evaluation indexes of hospitalization time and follow-up after operation. Results: all patients were treated by Transvaginal color Doppler ultrasound for the diagnosis of CSP, of which 10 cases (12.2%) before operation to clear the gestational sac and incision and surrounding tissues and by MRI (Magnetic resonance imaging) for further examination, all patients in the visible villi or histopathology showed the villi, and are consistent with the endogenous A scar pregnancy. B, the two groups of patients with age, menopause, pregnancy, abortion, admission blood human chorionic gonadotropin (Human Chorionic, Gonadotropin, HCG) level, the number of cesarean section, cesarean section from the last interval, there was no significant difference in maximum diameter distance lesions and lesions with uterine serosa the amount of bleeding (P0.05) in.A group, operation time and hospitalization costs were less than group B (P0.05), while the two group hospitalization time, the difference of serum beta -HCG decreased to normal time and postoperative menstrual recovery time without the There was no significant difference in the success rate between the two groups of endogenous A and B (chi 2=0.009, P=0.925). Conclusion: compared with the embryo cutting operation under the guidance of ultrasound, the P0.05 guided ultrasound guided operation is safer, simpler and more economical.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R713.8

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