本文選題：剖宮產(chǎn)瘢痕妊娠 + 治療�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：研究背景:剖宮產(chǎn)瘢痕妊娠是一種較少見的異位妊娠類型,發(fā)生率在1/2216~1/1800之間,但近年來臨床發(fā)病率呈上升趨勢(shì),CSP患者如果不能及時(shí)診斷及妥善治療,將會(huì)出現(xiàn)大出血、子宮破裂、子宮切除甚至危及患者的生命。但由于國(guó)內(nèi)外對(duì)剖宮產(chǎn)瘢痕妊娠的治療缺乏足夠有力的循證醫(yī)學(xué)依據(jù),目前CSP尚無規(guī)范統(tǒng)一的治療指南。因此,通過循證醫(yī)學(xué)探尋一種創(chuàng)傷小、恢復(fù)快、安全有效的治療方式對(duì)于最大限度的保護(hù)患者的健康、提高患者的生活質(zhì)量有重要意義。目的:研究子宮瘢痕妊娠的治療方法,對(duì)臨床應(yīng)用較多、創(chuàng)傷較小、患者接受度高的子宮動(dòng)脈化療栓塞術(shù)聯(lián)合清宮術(shù)、甲氨蝶呤聯(lián)合清宮術(shù)、陰式病灶切除術(shù)及腹腔鏡下病灶切除術(shù)等四種治療方式從治愈率、術(shù)中出血量、血β-h CG降至正常的時(shí)間、住院時(shí)間、住院費(fèi)用、月經(jīng)復(fù)潮的時(shí)間等多個(gè)觀察指標(biāo)進(jìn)行系統(tǒng)評(píng)價(jià)、薈萃分析。方法:依據(jù)《Systematic Review in Heath Care:Meta-analysis in Context》制作步驟,針對(duì)要評(píng)價(jià)的問題,確定納入和排除標(biāo)準(zhǔn)。制定檢索策略,利用計(jì)算機(jī)在線檢索Pubmed,Embase,Cochrane Library,Medline,OVID,Web of science;相關(guān)期刊論文(CNKI)、萬方數(shù)據(jù)庫(kù)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)服務(wù)系統(tǒng)(Sino Med)、重慶維普中文期刊全文數(shù)據(jù)庫(kù)(VIP)等,人工檢索吉林大學(xué)醫(yī)學(xué)圖書館相關(guān)雜志,全面搜集2012年1月至2016年12月中英文發(fā)表及未發(fā)表的剖宮產(chǎn)瘢痕妊娠治療方法的有關(guān)文獻(xiàn)。由兩位評(píng)價(jià)員獨(dú)立選擇研究、評(píng)估研究的質(zhì)量及提取數(shù)據(jù),使用Review Manager5.3軟件完成納入文獻(xiàn)的Meta分析。結(jié)果:兩位評(píng)價(jià)員依據(jù)納入及排除標(biāo)準(zhǔn)共納入文獻(xiàn)19篇,有關(guān)子宮動(dòng)脈化療栓塞術(shù)聯(lián)合清宮術(shù)及甲氨蝶呤聯(lián)合清宮術(shù)治療CSP的文獻(xiàn)15篇,有關(guān)陰式病灶切除術(shù)及腹腔鏡下病灶切除術(shù)治療CSP的文獻(xiàn)4篇。其中,533例患者行子宮動(dòng)脈化療栓塞術(shù)聯(lián)合清宮術(shù)治療,383例患者行甲氨蝶呤聯(lián)合清宮術(shù)治療,114例患者行陰式病灶切除術(shù),125例患者行腹腔鏡下病灶切除術(shù)。使用Review Manager5.3軟件進(jìn)行Meta分析,結(jié)果顯示:⑴子宮動(dòng)脈化療栓塞術(shù)聯(lián)合清宮術(shù)與甲氨蝶呤聯(lián)合清宮術(shù)治愈率對(duì)比,納入15篇文獻(xiàn),合并分析結(jié)果示:OR=2.5,95%CI為(1.43,4.38),Z=3.20,P=0.001,P0.05,兩組數(shù)據(jù)差異有統(tǒng)計(jì)學(xué)意義;子宮動(dòng)脈化療栓塞術(shù)聯(lián)合清宮術(shù)與甲氨蝶呤聯(lián)合清宮術(shù)術(shù)中出血量、血β-HCG降至正常的時(shí)間及住院費(fèi)用對(duì)比,因納入研究異質(zhì)性大,無法合并分析。⑵陰式病灶切除術(shù)與腹腔鏡下病灶切除術(shù)治愈率對(duì)比,納入4篇文獻(xiàn),合并分析結(jié)果示:RR=1.00,95%CI為(0.97,1.03),且Z=0.20,P=0.84,P0.05,兩組數(shù)據(jù)差異無統(tǒng)計(jì)學(xué)意義;術(shù)中出血量對(duì)比,納入3篇文獻(xiàn),合并分析結(jié)果示:SMD=1.17,95%CI為(0.82,1.51),且Z=6.68,P0.00001,P0.05,兩組數(shù)據(jù)差異有統(tǒng)計(jì)學(xué)意義;手術(shù)時(shí)間對(duì)比,納入文獻(xiàn)3篇,合并分析結(jié)果示:MD=25.23,95%CI為(20.08,30.38),且Z=9.61,P0.00001,P0.05,兩組數(shù)據(jù)差異有統(tǒng)計(jì)學(xué)意義;月經(jīng)復(fù)潮時(shí)間對(duì)比,納入文獻(xiàn)4篇,合并分析結(jié)果示:MD=0.76,95%CI為(-0.96,2.48),且Z=0.87,P=0.39,P0.05,兩組數(shù)據(jù)差異無統(tǒng)計(jì)學(xué)意義;血β-HCG降至正常的時(shí)間、住院費(fèi)用對(duì)比,因納入研究異質(zhì)性大,無法合并分析。結(jié)論:1.UAEC聯(lián)合清宮術(shù)治療CSP比MTX聯(lián)合清宮術(shù)治療CSP治愈率高,術(shù)中大出血及進(jìn)一步治療的概率低,為更安全有效的治療方式。2.陰式病灶切除術(shù)與腹腔鏡下病灶切除術(shù),治愈率無明顯差異,且治愈率均較高。3.陰式病灶切除術(shù)治療CSP比腹腔鏡下病灶切除術(shù)治療CSP術(shù)中出血量少,手術(shù)時(shí)間短,兩種方式治療CSP后,月經(jīng)復(fù)潮時(shí)間無明顯差異。
[Abstract]:Background: cesarean scar pregnancy is a rare type of ectopic pregnancy. The incidence rate is between 1/2216~1/1800, but in recent years the incidence of cicatricial pregnancy is rising. If CSP patients can not be diagnosed and treated properly, there will be massive hemorrhage, rupture of uterus, hysterectomy and even endanger the patient's life. The treatment of uterine cicatricial pregnancy lacks sufficient evidence of evidence-based medicine. At present, there is no standardized and unified guide for treatment in CSP. Therefore, it is of great significance to explore a kind of small trauma, quick recovery, safe and effective treatment through evidence-based medicine for the maximum protection of the health of the patients and the improvement of the quality of life of the patients. The treatment of cicatricial pregnancy has more clinical application and less trauma. Patients with high acceptability of uterine artery chemoembolization combined with uterine artery embolization, methotrexate combined with uterine resection, vaginal lesion excision and laparoscopic focus resection are four treatment methods from the cure rate, the amount of intraoperative bleeding, the time of blood beta -h CG to the normal time, hospitalization A systematic evaluation and meta analysis of several observation indexes, such as between the cost of hospitalization, the time of menstruation and tide, etc. methods: according to the steps of , the inclusion and exclusion criteria are determined for the problems to be evaluated. The retrieval strategy is formulated and the computer is used to retrieve Pubmed, Embase, Cochrane Li on the computer. Brary, Medline, OVID, Web of science; Chinese journal full text database (CNKI), Wanfang database, Chinese biomedical literature service system (Sino Med), Chongqing VP Chinese journal full text database (VIP), etc., manually retrieving the related miscellaneous records of the medical library of Jilin University, and collecting and unpublished in English from January 2012 to 12 2016. The literature on the treatment of caesarean scar pregnancy. Two evaluators independently selected the study to evaluate the quality and data of the study, and use the Review Manager5.3 software to complete the Meta analysis in the literature. Results: two evaluators included 19 articles in the literature according to the inclusion and exclusion criteria, and the uterine artery chemoembolization combined with the palace of Qing palace. 15 literature for the treatment of CSP with methotrexate combined with methotrexate, 4 articles about the treatment of CSP with vaginal lesion resection and laparoscopic lesion excision, of which 533 patients were treated with uterine artery chemoembolization combined with hysterectomy, 383 patients treated with methotrexate combined with hysterectomy, 114 patients with vaginal excision, 125 Patients underwent laparoscopic lesion excision. Meta analysis was performed using Review Manager5.3 software. The results showed: (1) the comparison of the curative rate of uterine artery chemoembolization combined with methotrexate combined with methotrexate was included in 15 articles. The combined analysis showed that OR=2.5,95%CI was (1.43,4.38), Z=3.20, P=0.001, P0.05, and the data of the two groups were different. Statistical significance: uterine artery chemoembolization combined with uterine artery embolization and methotrexate combined with the amount of bleeding, blood beta -HCG to normal time and hospital cost comparison, because of the large heterogeneity of the study, can not be combined analysis. (2) the comparison of the cure rate of vaginal lesion resection and laparoscopic resection, including 4 literature, merge points The results showed that: RR=1.00,95%CI was (0.97,1.03), and Z=0.20, P=0.84, P0.05, two groups of data differences were not statistically significant; the amount of bleeding in the operation was included in 3 articles, and the combined analysis results showed that SMD=1.17,95%CI was (0.82,1.51), and Z=6.68, P0.00001, P0.05, two groups of data differences were statistically significant; operation time comparison, included 3 articles, merge points. The results showed: MD=25.23,95%CI (20.08,30.38), and Z=9.61, P0.00001, P0.05, two groups of data differences were statistically significant; menstrual cycle time comparison, included in the literature 4, the combined analysis showed that MD=0.76,95%CI was (-0.96,2.48), and Z=0.87, P=0.39, P0.05, two groups of data differences without statistical significance; blood beta -HCG to normal time, hospitalization fee Conclusion: 1.UAEC combined with CSP is more effective in treating CSP than MTX, and the probability of large bleeding and further treatment is low, and there is no significant difference in the cure rate between.2. vaginal focus resection and laparoscopic focus resection. The cure rate was higher than that of.3. negative resection for the treatment of CSP compared with laparoscopic focus resection for the treatment of CSP with less bleeding and shorter operation time. There was no significant difference in the period of menstrual recovery after two ways of treating CSP.

【學(xué)位授予單位】：吉林大學(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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