發(fā)布時間：2018-07-07 07:56

  本文選題：子宮畸形 + 妊娠結(jié)局�。� 參考：《首都醫(yī)科大學》2017年碩士論文

【摘要】：研究背景:子宮畸形是女性生殖系統(tǒng)發(fā)育異常中最常見的一種,主要包括中隔子宮、雙子宮、雙角子宮、弓形子宮、單角子宮等。子宮畸形在非孕期往往無臨床癥狀,妊娠時由于宮腔形態(tài)失常及子宮內(nèi)膜發(fā)育不良能夠引起流產(chǎn)、早產(chǎn)、胎膜早破、胎位異常、胎兒生長受限等不良妊娠結(jié)局,剖宮產(chǎn)率也相應增加。不同類型子宮畸形形成原因不同,對妊娠結(jié)局的影響也不完全相同。在各種子宮畸形中,中隔子宮的發(fā)病率最高,文獻報道其最容易引起復發(fā)性流產(chǎn)。單角子宮則更容易引起胎位異常,剖宮產(chǎn)率也相對較高。關(guān)于不同類型子宮畸形對妊娠的影響,由于樣本量及統(tǒng)計學方法的不同,各研究結(jié)果并不一致,至今尚無統(tǒng)一的結(jié)論。子宮畸形患者妊娠時剖宮產(chǎn)率高達70%以上,胎位異常是主要原因。關(guān)于剖宮產(chǎn)術(shù)中是否行子宮畸形矯形術(shù)(主要涉及中隔子宮,單角+殘角子宮),考慮到會增加出血的風險,目前尚無確切的結(jié)論。目的:1.探討子宮畸形與妊娠結(jié)局的關(guān)系。2.研究不同類型子宮畸形分別對妊娠結(jié)局的影響。3.評估剖宮產(chǎn)術(shù)中行子宮畸形矯形術(shù)的安全性。方法:選取2011年至2015年在首都醫(yī)科大學附屬北京婦產(chǎn)醫(yī)院建檔并分娩的375例子宮畸形妊娠患者為研究對象,并隨機選取同期375例正常子宮妊娠患者作為對照。入組標準:年齡18-34歲,單胎妊娠,初產(chǎn)婦,無合并子宮肌瘤、子宮腺肌癥,無內(nèi)外科合并癥,既往無子宮肌瘤剔除術(shù)史及子宮畸形矯形術(shù)史。采集患者的一般資料信息:年齡,子宮畸形類型,診斷方法,孕次;產(chǎn)前情況:既往自然流產(chǎn)、稽留流產(chǎn)、人工流產(chǎn)、胎死宮內(nèi),胎膜早破,胎盤早剝,前置胎盤,胎兒窘迫,胎位異常;產(chǎn)時、產(chǎn)后情況:是否臍帶繞頸,分娩方式(陰道分娩、剖宮產(chǎn)),剖宮產(chǎn)指征,早產(chǎn),足月產(chǎn),分娩孕周,產(chǎn)后出血,胎盤粘連/滯留;新生兒情況:出生體重,1分鐘Apgar評分。采用SPSS17.0統(tǒng)計學軟件對數(shù)據(jù)進行統(tǒng)計分析,計量資料采用均數(shù)±標準差來描述,分析比較采用t檢驗或方差分析;計數(shù)資料以構(gòu)成比來表示,分析比較采用卡方檢驗、連續(xù)性矯正或Fisher確切概率法。P0.05為差異有統(tǒng)計學意義。結(jié)果:1.畸形組平均孕次高于對照組(1.64±0.91 VS 1.51±0.77,P=0.035);畸形組胎膜早破(29.9%VS 22.1%,P=0.016),產(chǎn)后出血(3.2%VS 1.1%,P=0.043),臍帶繞頸(31.5%VS 17.1%,P=0.000),胎位異常(46.9%VS 5.3%,P=0.000),早產(chǎn)(16.0%VS 4.0%,P=0.000),剖宮產(chǎn)(72.5%VS 18.4%,P=0.000)等發(fā)生率均顯著高于正常子宮組;而分娩孕周(37.78±1.96 VS 39.21±1.26,P=0.000),新生兒出生體重(3069.67±548.84 VS 3384.99±402.52,P=0.000),巨大兒發(fā)生率(1.3%VS 4.8%,P=0.006)均顯著低于正常子宮組。2.畸形組中,胎位異常、新生兒體重等方面的發(fā)生率在不同類型子宮畸形之間有明顯差異(P0.05)。單角子宮胎位異常的發(fā)生率最高(70.1%),雙子宮新生兒出生體重最低。3.本研究中22例中隔子宮患者于剖宮產(chǎn)術(shù)中切除中隔,12例單角+殘角子宮患者于術(shù)中行殘角子宮切除術(shù)。結(jié)果1例中隔子宮患者發(fā)生產(chǎn)后出血(4.5%),1例單角+殘角子宮患者發(fā)生產(chǎn)后出血(8.3%)。切除與未切除中隔的兩組患者在產(chǎn)后出血發(fā)生率(4.5%VS 2.8%,P=0.534)及產(chǎn)后出血量(442.27±160.77 VS385.47±153.55,P=0.120)方面差異均無統(tǒng)計學意義;術(shù)中行殘角子宮切除術(shù)患者的產(chǎn)后出血量(599.17±461.74 VS 365.77±149.17,P=0.003)明顯高于術(shù)中未行殘角子宮切除術(shù)的患者,而兩者在產(chǎn)后出血發(fā)生率方面差異并無統(tǒng)計學意義(8.3%VS 3.8%,P=0.470)。結(jié)論:子宮畸形患者妊娠時,胎膜早破、胎位異常、產(chǎn)后出血、早產(chǎn)等不良妊娠結(jié)局的發(fā)生風險會增加,剖宮產(chǎn)率也相應提高;單角子宮患者妊娠時胎位異常的發(fā)生率最高;關(guān)于剖宮產(chǎn)術(shù)中中隔子宮以及殘角子宮矯形術(shù)問題,建議在條件允許的情況下,對所有殘角子宮患者行殘角子宮+同側(cè)輸卵管切除術(shù)。臨床中對于子宮畸形患者應該及早明確診斷,加強孕產(chǎn)期保健,個體化治療,降低圍產(chǎn)期并發(fā)癥的發(fā)生。
[Abstract]:Background: uterine malformation is the most common type of abnormal development of female reproductive system, mainly including septum uterus, double uterus, double horned uterus, arched uterus, single angle uterus, etc.. Uterine malformation often has no clinical symptoms during non pregnancy. The incidence of cesarean section is also increased. The causes of different types of uterine malformation are different, and the influence on the pregnancy outcome is not exactly the same. Among the various uterine malformations, the incidence of the uterus is the highest, the literature is reported that it is the most likely to cause recurrent abortion. The single angle uterus is easier. The effect of different types of uterine malformation on pregnancy, due to the difference of sample size and statistical method, is not consistent, and there is no unified conclusion. The rate of cesarean section is up to 70%, and the abnormal fetal position is the main reason. In caesarean section Whether or not uterine malformation (mainly involving the septum, single angle, and residual angle uterus), there is no definitive conclusion in consideration of the risk of increasing bleeding. Objective: 1. to investigate the relationship between uterine malformation and pregnancy outcome (.2.) to study the effect of different types of uterine malformation on pregnancy outcome in.3. assessment of uterine malformation during cesarean section Methods: 375 cases of uterine malformed pregnancy were selected from 2011 to 2015 in Beijing Obstetrics and Gynecology Hospital of Capital Medical University, and 375 cases of normal uterine pregnancy were selected randomly as control. The standard of the group was 18-34 years old, single pregnancy, primipara, no uterine myoma and uterus. Adenomyosus, no internal surgery complication, history of myomectomy without uterine myomectomy and history of orthopedic surgery. Collect the general information of patients: age, type of uterus, diagnosis, pregnancy; prenatal abortion, abortion, abortion, fetal death, premature rupture of fetal membranes, placenta previa, fetal distress, fetal distress. Parturition: umbilical cord around the neck, delivery mode (vaginal delivery, cesarean section), cesarean section, premature delivery, term delivery, birth, pregnancy, pregnancy, postpartum hemorrhage, placental adhesion / retention; newborn conditions: birth weight, 1 minutes Apgar score. The data were statistically analyzed with SPSS17.0 software, and the measurement data were measured in mean number. T test or analysis of variance was used for analysis and comparison; count data were represented by composition ratio. Analysis compared with chi square test, continuous correction or Fisher exact probability.P0.05 was statistically significant. Results: the average pregnancy rate of 1. malformed groups was higher than that of the control group (1.64 + 0.91 VS 1.51 + 0.77, P=0.035), and the malformed group had premature rupture of membranes (29 .9%VS 22.1%, P=0.016), postpartum hemorrhage (3.2%VS 1.1%, P=0.043), umbilical cord around the neck (31.5%VS 17.1%, P=0.000), abnormal fetal position (46.9%VS 5.3%, P=0.000), premature birth (16.0%VS 4%, P=0.000), cesarean section (72.5%VS 18.4%, P=0.000), and so on were significantly higher than the normal uterus group; and birth pregnancy week (37.78 + 1.96 39.21 + 1.26,), newborn birth Weight (3069.67 + 548.84 VS 3384.99 + 402.52, P=0.000), the incidence of giant infants (1.3%VS 4.8%, P=0.006) was significantly lower than the normal uterine group.2. malformation group, abnormal fetal position, neonatal weight and other aspects of the incidence of different types of uterine abnormalities between different types of uterine abnormalities (P0.05). The incidence of single angle uterus fetal abnormalities (70.1%), Gemini In the study of the lowest birth weight of the uterus.3., 22 septate septum patients were excised during cesarean section and 12 cases of single angle + remnant angle hysterectomy were performed during the operation. Results 1 cases of septum uteri were treated with post production bleeding (4.5%), 1 cases of single angle + remnant uterus were produced after production (8.3%). Excision and unexcised septum were removed. There was no significant difference between the two groups in the incidence of postpartum hemorrhage (4.5%VS 2.8%, P=0.534) and postpartum hemorrhage (442.27 + 160.77 VS385.47 + 153.55, P=0.120), and the amount of postpartum hemorrhage (599.17 + 461.74 VS 365.77 + 149.17, P=0.003) in the surgical resection of the remnant angle hysterectomy was significantly higher than that of the non residual angle hysterectomy in the operation. There is no significant difference in the incidence of postpartum hemorrhage (8.3%VS 3.8%, P=0.470). Conclusion: the risk of premature rupture of membranes, abnormal fetal position, postpartum hemorrhage, preterm birth and other adverse pregnancy outcomes will increase, and the rate of cesarean section increases accordingly; the incidence of abnormality of fetal position during pregnancy in single horned uterus patients. With regard to the problem of the septum and the residual angle of the uterus during cesarean section, it is suggested that the hysterectomy of the remnant uterus and the ipsilateral salpingectomy for all patients with residual angle uterus should be performed under conditions permitted. Happen.
【學位授予單位】：首都醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.2

【參考文獻】

相關(guān)期刊論文 前10條

1 叢建萍;聶小毳;;殘角子宮妊娠4例臨床分析[J];中國醫(yī)藥指南;2016年17期

2 朱潁;曹云霞;;子宮發(fā)育異�；颊呷焉锝Y(jié)局分析[J];安徽醫(yī)科大學學報;2016年07期

3 鄭芳媛;周毓青;隋龍;任蕓蕓;戴蓓蓓;林如;;超聲不同成像方法診斷子宮畸形的比較研究[J];中華醫(yī)學超聲雜志(電子版);2016年05期

4 李金玉;王明;楊保軍;馬雪蓮;馮力民;;60例宮腔鏡下經(jīng)宮頸子宮縱隔切除術(shù)的臨床分析[J];中國計劃生育和婦產(chǎn)科;2015年07期

5 梁娜;吳青青;高鳳云;李菁華;郭翠霞;田源;;經(jīng)陰道三維子宮輸卵管超聲造影診斷先天性子宮畸形的應用價值[J];中國超聲醫(yī)學雜志;2015年06期

6 虞楊;王琪;石中華;;不同類型子宮畸形對晚期妊娠結(jié)局的影響[J];南京醫(yī)科大學學報(自然科學版);2014年11期

7 馬菁苒;朱蘭;;先天性子宮畸形的分類、診斷及類型鑒別[J];協(xié)和醫(yī)學雜志;2014年04期

8 薛勤;吳群英;譚潔;吳媛;;子宮內(nèi)妊娠合并殘角子宮妊娠破裂一例[J];中華婦產(chǎn)科雜志;2014年03期

9 鄭亮慧;陳素清;劉照貞;林琳;;殘角子宮妊娠6例臨床分析[J];福建醫(yī)藥雜志;2014年01期

10 馮桂梅;肖麗;黃薇;王秋毅;;宮腔鏡下子宮中隔切除術(shù)后放置宮內(nèi)節(jié)育器及應用激素補充治療對術(shù)后妊娠結(jié)局的影響[J];實用婦產(chǎn)科雜志;2013年10期

，

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