本文選題：子宮切口妊娠 + 子宮動脈灌注栓塞術　； 參考：《天津醫(yī)科大學》2014年碩士論文

【摘要】：目的：比較子宮動脈灌注栓塞術(uterus artery infusion embolization, UAIE),甲氨蝶呤(nnethotrexate, MTX)胎囊局部注射、MTX全身用藥、陰式子宮切口瘢痕妊娠病灶清除術+子宮肌壁修補術(Transvaginal Cesarean Scar Pregnancy Debridement Surgery and Myometrium Neoplasty, TCSPDS-MN)治療子宮切口妊娠(Cesarean Scar Pregnancy, C SP)的臨床效果,探討不同臨床處理方案的優(yōu)缺點,為子宮切口妊娠的臨床治療提供依據(jù)。 方法：對2009年9月至2013年12月天津市天和醫(yī)院(現(xiàn)天津醫(yī)院)和2010年10月至2013年12月天津市中心婦產(chǎn)科醫(yī)院的子宮切口妊娠352例進行回顧性分析,其中UAIE138例,MTX胎囊局部注射83例,MTX全身用藥66例,陰式子宮切口瘢痕妊娠病灶清除術+子宮肌壁修補術65例。全面收集上述四組患者的臨床病例資料,分析比較同時行清宮術者的術中出血量、手術時間、住院時間、住院費用、并發(fā)癥、術后陰道出血時間、術后β-HCG下降情況,治療成功率,并遠期隨訪UAIE組術后及全身MTX組月經(jīng)復潮時間、術后3、6個月雌二醇(E2)、促卵泡生成素(FSH)水平、卵巢大小等指標,評價子宮動脈栓灌注塞術對于卵巢功能的影響。 結(jié)果： 1.陰式手術組術后陰道出血時間及住院時間最短,術后血β-HCG下降最明顯,其次是UAIE組,全身MTX組最慢(F=42.89,P0.001)。 2. UAIE組手術時間及術中出血量明顯少于其它三組,其次是陰式手術(F=20.42,P0.001)。陰式手術時間長于局部MTX組及UAIE組(F=41.75,P0.001)。 3.住院費用UAIE最高(平均13612±2642元),陰式手術其次,全身MTX組及局部MTX組費用無明顯差異(P0.05)。 4.四組治療方案中陰式手術組成功率最高(成功率：87.7%),全身MTX治療最低(成功率為54.5%, F=0.12,P=0.73)；且全身MTX治療的副反應最大。 結(jié)論： 1.子宮動脈灌注栓塞術后行清宮術能充分阻斷子宮動脈血流,局部MTX濃度高,大大降低術中及術后大出血的風險性,并且保留子宮完整性,對卵巢功能無明顯影響,仍是目前子宮切口妊娠的首選治療方法。 2.子宮切口瘢痕妊娠病灶清除術+子宮肌壁修補術作為一種全新的微創(chuàng)CSP治療方法,具有一次完全清除病灶、保留患者生育功能、住院時間短、恢復快、術后陰道出血時間短,血β-HCG下降快等優(yōu)勢,日益受到臨床重視,應用日益廣泛。 3.MTX超聲引導下胎囊局部注射治療,毒副反應明顯低于全身用藥組,住院費用低,對儀器設備和醫(yī)生手術技能要求低,易操作,但具有住院時間長、血β-HCG下降緩慢、陰道出血時間長等缺點,但對于低收入人群和偏遠地區(qū)不失為一種良好選擇。 4.MTX全身用藥毒副反應相對較多,成功率低,且住院時間長,陰道出血時間長、血β-HCG下降緩慢,目前此種治療方法不作為治療CSP的常規(guī)方法。
[Abstract]:Objective: to compare the systemic administration of intrauterine arterial infusion embolization (artery infusion embolization,) with intrauterine injection of artery infusion embolization, methotrexate (MTX) into fetal sac. Clinical effect of Transvaginal Cesarean Scar Pregnancy Debridement Surgery and Myometrium Neoplasty, TCSPDS-MNs in the treatment of pregnancy Cesarean Scar Pregnancy, C SP) of uterine incision, the advantages and disadvantages of different clinical treatments were discussed. To provide the basis for the clinical treatment of uterine incision pregnancy. Methods: from September 2009 to December 2013, 352 cases of uterine incision pregnancy in Tianjin Tianhe Hospital (now Tianjin Hospital) and Tianjin Central Gynecology and Obstetrics Hospital from October 2010 to December 2013 were retrospectively analyzed. Among them, 66 cases were treated with UAIE138 and 66 cases were treated with MTX by local injection of fetal sac, 65 cases were treated with uterine muscle wall repair. The clinical data of the four groups were collected, and the blood loss, operation time, hospitalization cost, complications, vaginal bleeding time, and the decrease of 尾 -HCG were analyzed and compared. The success rate of treatment, and long-term follow-up of UAIE group and systemic MTX group menstrual resuscitation time, estradiol E _ 2, follicle stimulating hormone (FSH) level, ovarian size and other indicators, to evaluate the impact of uterine artery embolization on ovarian function. Results: 1. The vaginal bleeding time and hospitalization time were the shortest in the vaginal operation group, and the decrease of serum 尾 -HCG was the most obvious, followed by the UAIE group, and the slowest FV 42.89 渭 m P 0.001 in the systemic MTX group. 2. The time of operation and the amount of intraoperative bleeding in UAIE group were significantly less than those in other three groups. The time of negative operation was longer than that of local MTX group and UAIE group. 3. The cost of UAIE was the highest (mean 13612 鹵2642 yuan) in hospitalization, followed by vaginal operation. There was no significant difference between systemic MTX group and local MTX group (P 0.05). 4. In the four groups, the success rate of negative operation group was the highest (success rate: 87.7%), and that of systemic MTX treatment was the lowest (the success rate was 54.5%, FG 0.12 P < 0.73%), and the side effect of systemic MTX treatment was the largest. Conclusion: 1. Uterine artery blood flow can be blocked by uterine artery infusion embolization, local MTX concentration is high, the risk of massive bleeding during and after operation is greatly reduced, uterine integrity is preserved, and ovarian function is not significantly affected. It is still the first choice of treatment for uterine incision pregnancy. 2. Repair of uterine muscle wall as a new minimally invasive CSP method for uterine incision scar pregnancy focus debridement has the advantages of complete clearance of the lesion, retention of the patient's fertility function, short hospitalization time, rapid recovery, and short postoperative vaginal bleeding time. Blood 尾-HCG has been paid more and more attention and widely used because of its rapid decline. Under the guidance of 3.MTX ultrasound, the side effect of local injection of fetal sac was obviously lower than that of the whole body medication group, the cost of hospitalization was low, the requirement of instrument and medical operation skill was low, the operation skill was easy to operate, but the hospitalization time was long, and the blood 尾 -HCG decreased slowly. Long vaginal bleeding is a good choice for low-income people and remote areas. There are relatively many side effects, low success rate, long hospital stay, long vaginal bleeding time and slow decrease of blood 尾 -HCG in 4.MTX. At present, this treatment method is not a routine method for the treatment of CSP.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R713.8

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