本文選題：瘢痕妊娠 + 剖宮產(chǎn)術(shù)��； 參考：《鄭州大學》2014年碩士論文

【摘要】：剖宮產(chǎn)瘢痕部位妊娠（caesarean scar pregnancy，CSP），是指有剖宮產(chǎn)史孕婦，胚胎著床于子宮下段剖宮產(chǎn)切口瘢痕處[1]，國內(nèi)多數(shù)文獻稱子宮下段剖宮產(chǎn)切口處妊娠，是一種特殊類型的異位妊娠，患者常因合并胎盤植入、子宮破裂、大出血行子宮切除術(shù)而失去生育能力，甚至失去生命。近年來隨著剖宮產(chǎn)率的逐年上升和陰道超聲技術(shù)的臨床應(yīng)用，CSP的發(fā)病率和檢出率也隨之增加，，嚴重威脅著育齡期婦女的生殖健康及生命安全。本文旨在探討CSP發(fā)病的影響因素，為減少和預防CSP發(fā)生提供理論依據(jù)。 目的 通過回顧性分析CSP患者的既往剖宮產(chǎn)子宮切口縫合方式、孕產(chǎn)史、既往剖宮產(chǎn)術(shù)前術(shù)中異常情況等臨床資料，探討CSP發(fā)病的影響因素，為減少和預防CSP的發(fā)生提供理論依據(jù)。 材料與方法 1.選取2003年1月至2013年7月在鄭州大學第三附屬醫(yī)院就診的53例瘢痕妊娠患者為CSP組，選取同期疤痕子宮合并宮內(nèi)妊娠患者95例作為對照組；CSP組和對照組患者的既往剖宮產(chǎn)術(shù)均在本院進行，且手術(shù)方式均為子宮下段剖宮產(chǎn)術(shù)。 2.回顧性分析53例CSP患者的臨床資料，對CSP患者的年齡、孕產(chǎn)史孕次、人工流產(chǎn)次數(shù)、剖宮產(chǎn)次數(shù)㖞、既往剖宮產(chǎn)子宮切口縫合方式連續(xù)漿肌全層單層縫合和連續(xù)縫合肌層、漿膜層包埋雙層縫合㖞、既往剖宮產(chǎn)術(shù)前術(shù)中異常情況胎膜早破、胎盤早剝、人工胎盤剝離術(shù)、臀位剖宮產(chǎn)㖞及距前次剖宮產(chǎn)時間等因素與CSP發(fā)病的關(guān)系進行整理分析。 3.采用SPSS17.0軟件包，將臨床整理所得數(shù)據(jù)錄入建立數(shù)據(jù)庫并進行統(tǒng)計分析，定性資料，采用2檢驗，以α＝0.05為檢驗水準。 結(jié)果 1CSP組與對照組不同年齡的比較 CSP患者集中于31～40歲，但與對照組相比，兩組在年齡分布上無統(tǒng)計學差異P＞0.05㖞。 2CSP組與對照組孕產(chǎn)史情況的比較 53例CSP患者在孕次方面差異無統(tǒng)計學意義P＞0.05㖞；人工流產(chǎn)≥2次38例（71.7%），剖宮產(chǎn)≥2次30例（56.6%），均高于對照組，兩組之間差異均有統(tǒng)計學意義（P＜0.05）。 3CSP組與對照組既往剖宮產(chǎn)子宮切口縫合方式的比較 53例CSP患者單層縫合方式30例（56.6%），高于對照組，兩組之間差異具有統(tǒng)計學意義（P＜0.05）。 4CSP組與對照組既往剖宮產(chǎn)術(shù)前術(shù)中異常情況的比較 53例CSP患者胎膜早破25例（47.2%），臀位剖宮產(chǎn)20例（37.7%），均高于對照組，差異有統(tǒng)計學意義（P＜0.05)；胎盤早剝7例（13.2%），低于對照組，但差異無統(tǒng)計學意義P＞0.05)；人工胎盤剝離術(shù)8例（15.1%），低于對照組，差異有統(tǒng)計學意義（P＜0.05)。其中CSP組胎膜早破合并胎盤早剝4例，胎膜早破合并臀位剖宮產(chǎn)2例，人工胎盤剝離合并臀位剖宮產(chǎn)1例。 5CSP組與對照組距前次剖宮產(chǎn)時間的比較 CSP組和對照組在距前次剖宮產(chǎn)時間分布上有統(tǒng)計學差異（P＜0.05)，其中距前次剖宮產(chǎn)時間≤5年37例（69.8%），高于對照組，2＝4.646，P＝0.031；≥16年2例（3.8%），比率低于對照組，2＝4.241，P＝0.039，兩組之間差異均有統(tǒng)計學意義（P＜0.05)。 結(jié)論 1.既往剖宮產(chǎn)子宮切口縫合方式是CSP發(fā)病的影響因素。 2.多次人工流產(chǎn)史、多次剖宮產(chǎn)史、胎膜早破、臀位剖宮產(chǎn)及距前次剖宮產(chǎn)時間是CSP發(fā)病的影響因素。
[Abstract]:In recent years , with the increasing of cesarean section rate and clinical application of vaginal ultrasound , the incidence and detection rate of CSP is increasing , which seriously threatens the reproductive health and life safety of women in childbearing age . In recent years , with the increase of cesarean section rate and the clinical application of vaginal ultrasound technique , the incidence and the life safety of women in childbearing age are seriously threatened . In recent years , this paper aims to explore the influential factors of CSP pathogenesis , and provide theoretical basis for reducing and preventing CSP .

Purpose

In order to reduce and prevent the occurrence of CSP in CSP patients , the clinical data of the prior cesarean section , the history of pregnancy and the abnormalities of previous cesarean section were analyzed retrospectively .

Materials and Methods

1 . In the third Affiliated Hospital of Zhengzhou University from January 2003 to July 2013 , 53 patients with scar pregnancy were selected as CSP group , and 95 patients with scar uterus and intrauterine pregnancy were selected as control group .
Prior cesarean section was performed in both the CSP group and the control group , and the procedure was performed in the lower section of the uterus .

2 . The clinical data of 53 patients with CSP were analyzed retrospectively , including the age , the history of pregnancy , the number of abortions , the number of times of cesarean section , the number of cesarean sections , the previous cesarean section , the continuous suture and the continuous suture muscle layer , the serosa - embedding double - layer suture , the abnormalities of the previous cesarean section , the premature rupture of the fetal membranes , the placental abruption , the manual placenta stripping , the breech section cesarean section and the relationship between the factors such as the time before the previous cesarean section and the pathogenesis of CSP .

3 . Using SPSS 17.0 software package , the data entered into the database was entered into the database and the statistical analysis and qualitative data were analyzed . The qualitative data were analyzed by 2 tests , with 偽 = 0.05 as the test level .

Results

Comparison of age between 1CSP group and control group

Compared with the control group , there was no statistical difference between the two groups in the age distribution compared with the control group ( P > 0.05 ) .

Comparison between 2CSP group and control group ' s history of pregnancy

There was no statistical difference in the pregnant time between 53 patients with CSP ? P > 0.05 ?
There were 38 cases ( 71.7 % ) induced by artificial abortion , 30 cases ( 56.6 % ) in cesarean section and 30 cases ( 56 . 6 % ) respectively , which were significantly higher than those in control group ( P < 0.05 ) .

Comparison between 3CSP group and control group prior cesarean section suture method

In 53 patients with CSP , 30 cases ( 56.6 % ) were single - layer suture , which was higher than that of the control group ( P < 0.05 ) .

Comparison of abnormal cases in 4CSP group and control group before cesarean section

In 53 patients with CSP , 25 cases ( 47.2 % ) had PROM and 20 cases ( 37.7 % ) were higher than those in the control group ( P < 0.05 ) .
The placental abruption in 7 cases ( 13.2 % ) was lower than that of the control group , but the difference was not statistically significant ( P > 0.05 ) .
In 8 cases ( 15.1 % ) of artificial placenta , the difference was statistically significant ( P < 0.05 ) . Among them , there were 4 cases of PROM , 4 cases of PROM , 2 cases of PROM , 2 cases of cesarean section , 1 case of artificial placenta and 1 case of cesarean section .

Comparison of the time of cesarean section between 5CSP group and control group

There was statistical difference ( P < 0.05 ) between CSP group and control group ( P < 0.05 ) in the previous cesarean section time 鈮

本文編號：1818752