本文選題：剖宮產(chǎn)瘢痕妊娠 + 刮宮術(shù)�。� 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的分析比較本院治療剖宮產(chǎn)瘢痕妊娠的選擇方式及臨床療效。方法收集本院2016年1月至2016年12月收治的274例剖宮產(chǎn)瘢痕妊娠患者,根據(jù)不同的處理方式進(jìn)行分組及統(tǒng)計(jì)分析。A組:直接B超引導(dǎo)下刮宮術(shù)(備子宮動(dòng)脈栓塞術(shù))193例。B組:雙側(cè)子宮動(dòng)脈栓塞術(shù)+甲氨蝶呤動(dòng)脈灌注化療+B超引導(dǎo)下刮宮術(shù)74例。C組:宮腔鏡下子宮峽部妊娠物電切割(伴或不伴雙側(cè)子宮動(dòng)脈栓塞術(shù)+甲氨蝶呤動(dòng)脈灌注化療)2例。D組:剖宮取胎(術(shù)前72小時(shí)內(nèi)予雙側(cè)髂內(nèi)動(dòng)脈球囊置入術(shù)或雙側(cè)子宮動(dòng)脈栓塞術(shù)處理)5例。C、D兩組例數(shù)較少,統(tǒng)計(jì)困難。本文主要比較A、B兩組孕周、胚囊大小、瘢痕厚度、瘢痕處血流、術(shù)中出血量、術(shù)前血人絨毛膜促性腺激素水平、血人絨毛膜促性腺激素下降速率、術(shù)后并發(fā)癥發(fā)生比例、再入院比例、術(shù)后住院時(shí)間、住院費(fèi)用情況。結(jié)果我院2016年1月至2016年12月收治的274例剖宮產(chǎn)瘢痕妊娠患者中,Ⅰ型剖宮產(chǎn)瘢痕妊娠占34.0%,Ⅱ型占57.6%,Ⅲ型占8.4%。因彩色多普勒超聲檢查發(fā)現(xiàn)異常入院的剖宮產(chǎn)瘢痕妊娠患者占39.4%,因陰道流血入院的占48.5%,因腹痛入院的占3.7%,因陰道流血伴腹痛入院的占2.2%,要求終止妊娠入院的占6.2%。A組:193例剖宮產(chǎn)瘢痕妊娠患者手術(shù)治療均成功,未發(fā)生術(shù)中并發(fā)癥,孕周小于等于7周者59.6%,胚囊小于等于2.5cm者61.5%,瘢痕厚度大于等于3mm者47.2%,瘢痕處血流不豐富者65.2%,平均術(shù)前人絨毛膜促性腺激素水平(40342±45897)IU/L,術(shù)中出血量小于等于100ml者96.9%,術(shù)后平均人絨毛膜促性腺激素下降速率(67.0±11.2)%,術(shù)后平均住院時(shí)間(4.5±1.6)天,平均住院費(fèi)用(3489.1±2258.1)元,術(shù)后再入院者3.1%。B組:74例剖宮產(chǎn)瘢痕妊娠患者手術(shù)均成功,發(fā)生術(shù)中并發(fā)癥者39.2%,孕周小于等于7周者43.2%,胚囊小于等于2.5cm者30.6%,瘢痕厚度大于等于3mm者17.6%,瘢痕處血流不豐富者22.5%,平均術(shù)前HCG水平(69257±59676)IU/L,術(shù)中出血量小于等于100ml者91.9%,術(shù)后平均HCG下降速率(73.9±11.2)%,術(shù)后平均住院時(shí)間(6.4±1.9)天,平均住院費(fèi)用(12230.8±1624.6)元,術(shù)后再入院者8.1%。C組:2例剖宮產(chǎn)瘢痕妊娠患者手術(shù)治療均成功,均發(fā)生術(shù)中并發(fā)癥,孕周小于等于7周者50%,胚囊小于等于2.5cm者50%,無瘢痕厚度大于等于3mm者,瘢痕處血流不豐富者50%,平均術(shù)前人絨毛膜促性腺激素水平(59395.5±77110.7)IU/L,術(shù)中出血量小于等于100ml者100%,術(shù)后平均人絨毛膜促性腺激素下降速率(68.3±19.7)%,術(shù)后平均住院時(shí)間(4.5±0.7)天,平均住院費(fèi)用(10125±4748.9)元,無術(shù)后再入院者。D組:5例剖宮產(chǎn)瘢痕妊娠患者手術(shù)治療均成功,發(fā)生術(shù)中并發(fā)癥者80%,無孕周小于等于7周者,無胚囊小于等于2.5cm者,無瘢痕厚度大于等于3mm者,瘢痕處血流不豐富者40%,平均術(shù)前人絨毛膜促性腺激素水平(75098.5±20426.2)IU/L,術(shù)中出血量小于等于100ml者20%,術(shù)后平均人絨毛膜促性腺激素下降速率(90.6±1.4)%,術(shù)后平均住院時(shí)間(9.2±3.6)天,平均住院費(fèi)用(24112.8±3639.7)元,無術(shù)后再入院者。A、B兩組孕周、胚囊大小、瘢痕厚度、瘢痕處血流豐富程度、術(shù)前血人絨毛膜促性腺激素水平、血人絨毛膜促性腺激素下降速率、術(shù)后并發(fā)癥發(fā)生比例、術(shù)后住院時(shí)間、住院費(fèi)用情況差距有統(tǒng)計(jì)學(xué)意義(P0.05)。A、B兩組術(shù)中出血量、再入院比例差異無統(tǒng)計(jì)學(xué)意義(P0.05)。因C、D組例數(shù)較少,未行統(tǒng)計(jì)學(xué)分析。結(jié)論孕周小于等于7周者、胚囊小于等于2.5cm者、瘢痕厚度大于等于3mm者、瘢痕處血流不豐富者、術(shù)前血人絨毛膜促性腺激素水平較低者,可首選B超引導(dǎo)下刮宮術(shù)。反之,孕周大于7周者、胚囊大于2.5cm者、瘢痕厚度小于3mm者、瘢痕處血流較豐富者、術(shù)前血人絨毛膜促性腺激素水平較高者,可選擇雙側(cè)子宮動(dòng)脈栓塞術(shù)+甲氨蝶呤動(dòng)脈灌注化療+B超引導(dǎo)下刮宮術(shù),且此種術(shù)式有較好的治療效果。
[Abstract]:Objective to compare the clinical efficacy and treatment of cesarean scar pregnancy. Methods selection of our hospital from January 2016 to December 2016 were 274 cases of cesarean scar pregnancy patients, grouping and statistical analysis.A group according to the different methods: direct ultrasound guided curettage (by scraping the uterine artery embolization in 193 cases).B group: bilateral uterine artery embolization + methotrexate artery chemotherapy + ultrasound guided curettage in 74 cases.C group: Hysteroscopic uterine isthmus pregnancy electric cutting (with or without bilateral uterine artery embolization plus methotrexate arterial infusion chemotherapy) in 2 cases of.D group: Caesarean section (72 hours before surgery for bilateral iliac in artery balloon implantation or bilateral uterine artery embolization in treatment of 5 cases of.C, two D) group, the small number of cases, statistical difficulties. This paper mainly compares A, B two groups of gestational sac size, scar scar thickness, blood flow, bleeding, surgery The blood hCG levels, blood HCG decreased rate of complications after operation, the proportion, ratio of re hospitalization, postoperative hospitalization time, hospitalization cost. The results of our hospital from January 2016 to December 2016 treated 274 cases of cesarean scar pregnancy patients, type of cesarean scar pregnancy type II accounted for 34%, accounting for 57.6%, accounting for 8.4%. of type III by color Doppler ultrasound examination found abnormal hospital cesarean scar pregnancy accounted for 39.4% of patients hospitalized due to vaginal bleeding admitted to hospital because of abdominal pain accounted for 48.5%, accounted for 3.7%, because of vaginal bleeding with abdominal pain into the hospital accounted for 2.2%, to terminate the pregnancy hospital for 6.2%.A group 193 cases with cesarean scar pregnancy surgery were successful, no complications occurred, 7 weeks pregnant Zhou Xiaoyu is equal to 59.6%, the embryo sac is less than or equal to 2.5cm 61.5%, 3mm 47.2% is greater than or equal to the thickness of the scar, scar not rich blood flow in 65 .2%, the average of the previous hCG level (40342 + 45897) IU/L, the amount of intraoperative bleeding is less than or equal to 96.9% 100ml, the average human chorionic gonadotropin decreased rate of postoperative (67 + 11.2)%, the average hospitalization time after operation (4.5 + 1.6) days, the average hospitalization expenses (3489.1. 2258.1 yuan), readmission in 3.1%.B group after surgery: 74 cases of cesarean scar pregnancy patients were successful operation, complications occurred in 39.2%, 7 weeks pregnant Zhou Xiaoyu is equal to 43.2%, the embryo sac is less than or equal to 2.5cm 30.6%, 3mm 17.6% is greater than or equal to the thickness of the scar, scar not rich blood flow in 22.5% patients, the average the level of HCG (69257 + 59676) IU/L, the amount of intraoperative bleeding is less than or equal to 91.9% 100ml, the average rate decreased after HCG (73.9 + 11.2)%, the average hospitalization time after operation (6.4 + 1.9) days, the average hospitalization expenses (12230.8 + 1624.6), then the hospital after operation in 8.1%.C group: 2 cases of cesarean scar pregnancy patients Surgical treatment was successful, postoperative complications occurred, 7 weeks pregnant Zhou Xiaoyu is equal to 50%, the embryo sac is less than or equal to 2.5cm 50%, no scar thickness greater than or equal to 3mm, the scar not rich blood flow in 50% patients, the average of previous hCG levels (59395.5 + 77110.7) IU/L, the amount of intraoperative bleeding is less than or equal to 100ml 100%, the average human chorionic gonadotropin decreased rate of postoperative (68.3 + 19.7)%, the average hospitalization time after operation (4.5 + 0.7) days, the average hospitalization expenses (10125 + 4748.9) yuan, readmission in.D group after operation: 5 cases of cesarean scar pregnancy patients with surgical treatment success, complications occurred in 80%, no pregnant Zhou Xiaoyu is 7 weeks, no embryo sac is less than or equal to 2.5cm, no scar thickness greater than or equal to 3mm, the scar not rich blood flow in 40% patients, the average of previous hCG levels (75098.5 + 20426.2) IU/L, the amount of intraoperative bleeding is less than or equal to 100ml In 20%, the average human chorionic gonadotropin decreased rate of postoperative (90.6 + 1.4)%, the average hospitalization time after operation (9.2 + 3.6) days, the average hospitalization expenses (24112.8 + 3639.7), no postoperative readmission were.A, B two groups of gestational sac size, thickness of the scar, scar at the richness, preoperative blood hCG levels, blood HCG decline rate, the proportion of complications after operation, postoperative hospitalization time, hospitalization expenses gap was statistically significant (P0.05).A, B two sets of blood loss, no statistically significant differences in the proportion of readmission (P0.05). Because of the C D group, the small number of cases, without statistical analysis. Conclusion the gestational age is less than or equal to 7 weeks, the embryo sac is less than or equal to 2.5cm, the scar thickness is greater than or equal to 3mm, the scar not rich blood flow, preoperative blood HCG level is low, can be the first choice of ultrasound under the guidance of curettage and, The gestational age of more than 7 weeks, the embryo sac is greater than 2.5cm, less than 3mm thickness of the scar, scar rich blood, preoperative blood hCG levels higher, can choose bilateral uterine artery embolization + methotrexate artery chemotherapy + ultrasound guided curettage, and this kind of surgery has better effect of treatment.

【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)】：R714.22
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本文編號(hào)：1738556