本文選題：瘢痕妊娠 + 人流��； 參考：《中國實用婦科與產(chǎn)科雜志》2017年02期

【摘要】：目的探討瘢痕妊娠人工流產(chǎn)(人流)或清宮術中術后出現(xiàn)大量出血的原因、處理方法和臨床預后。方法對廣州醫(yī)科大學附屬第三醫(yī)院2005年1月至2014年12月收治的83例行人流或清宮術中術后大量出血、診斷為瘢痕妊娠患者的臨床資料進行回顧性分析,包括停經(jīng)天數(shù)、出血情況、處理方法、血β-h CG下降至正常時間、陰式超聲監(jiān)測宮內(nèi)妊娠包塊消失情況、治療3個月后陰式超聲瘢痕修復情況等。結(jié)果診斷:所有病例均經(jīng)陰道超聲、陰式三維彩超、手術或病理檢查確診為瘢痕妊娠。處理:30例人流或清宮術中術后大量出血病人(大出血組),其中5例急診行(次)全子宮切除術控制出血,另外25例急診行子宮動脈栓塞術,出血控制后,5例未予輔助治療、7例輔以保守治療、6例輔以保守手術、7例輔以清除修補術;另53例人流或清宮術后不規(guī)則陰道流血10~132 d(出血組),17例保守治療、15例保守手術、21例清除修補術。療效:子宮動脈栓塞術(UAE)組、保守治療組、保守手術組或清除修補手術組治療后陰道流血時間、血β-h CG降至正常、宮腔內(nèi)異常包塊消失、正常月經(jīng)恢復時間、恢復后第1次月經(jīng)經(jīng)期、治療后瘢痕愈合不良或者憩室比率依次減少,差異有統(tǒng)計學意義。結(jié)論有剖宮產(chǎn)史患者再次妊娠,需常規(guī)行陰式三維彩超檢查,及早排除瘢痕妊娠;未明確排除者于人流或清宮術中術后大量出血,應高度警惕瘢痕妊娠;UAE是緊急控制陰道流血的有效措施,保守手術或清除修補術短期臨床療效較為確切。
[Abstract]:Objective to investigate the causes, treatment and clinical prognosis of massive bleeding in scar pregnancy induced abortion or uterine clearing. Methods from January 2005 to December 2014, 83 patients with massive bleeding during or after operation and diagnosis of scar pregnancy in the third affiliated Hospital of Guangzhou Medical University were retrospectively analyzed, including the days of menopause. Bleeding, treatment, blood 尾 -hCG decreased to normal time, vaginal ultrasound monitoring the disappearance of intrauterine pregnancy mass, after 3 months of treatment, the repair of ultrasonic scar. Results: all cases were diagnosed as scar pregnancy by transvaginal ultrasound, 3 D ultrasonography, operation or pathology. To deal with 30 cases of massive bleeding during or after operation of abortion or uterine clearing (large bleeding group), 5 cases were treated with emergency hysterectomy to control bleeding, and 25 cases were treated with uterine artery embolization. After hemorrhage control, 5 cases were not treated with adjuvant treatment, 7 cases were treated with conservative treatment, 6 cases were treated with conservative operation and 7 cases were treated with removal and repair. Another 53 cases had irregular vaginal bleeding for 10 ~ 132 days (bleeding group, 17 cases were treated conservatively, 15 cases were treated conservatively, 21 cases were removed and repaired). Curative effect: uterine artery embolization (UAE) group, conservative treatment group, conservative operation group or purge repair operation group after treatment vaginal bleeding time, blood 尾 -hCG decreased to normal, intrauterine abnormal mass disappeared, normal menstrual recovery time, In the first menstrual period after recovery, the rate of scar healing or diverticulum decreased in turn, the difference was statistically significant. Conclusion for the patients with history of cesarean section, it is necessary to routinely perform three dimensional sonography in order to remove scar pregnancy as early as possible. The UAE of scar pregnancy is an effective measure to control vaginal bleeding urgently. The short-term clinical effect of conservative operation or removal and repair is more accurate.
【作者單位】： 廣州醫(yī)科大學附屬第三醫(yī)院婦產(chǎn)科廣東省產(chǎn)科重大疾病重點實驗室廣東省普通高校生殖與遺傳重點實驗室廣州]，

本文編號：1920516