發(fā)布時(shí)間：2018-08-04 18:43

【摘要】：目的:本研究分析了CSP(Caesarean scar pregnancy,剖宮產(chǎn)瘢痕妊娠)患者的發(fā)病年齡、全身因素、剖宮產(chǎn)情況、子宮切口縫合方式以及術(shù)后恢復(fù)情況等臨床資料,探討了CSP發(fā)病的影響因素,為降低和預(yù)防CSP的發(fā)生提供理論依據(jù)。方法:本研究選取2008年1月-2016年10月在就診的51例CSP患者作為實(shí)驗(yàn)組(CSP組);選取同期59例剖宮產(chǎn)術(shù)后妊娠位置正常者為對(duì)照組。分別對(duì)兩組對(duì)象的臨床資料進(jìn)行回顧性分析,包括年齡、全身情況(體重指數(shù)、貧血情況、慢性病史、盆腹腔手術(shù)史等)、子宮位置、剖宮產(chǎn)情況(剖宮產(chǎn)原因,術(shù)前陰道試產(chǎn)過程等)、孕產(chǎn)史(總孕產(chǎn)次、人工流產(chǎn)次數(shù)、剖宮產(chǎn)次數(shù)等)、切口縫合方式及距前次剖宮產(chǎn)時(shí)間、剖宮產(chǎn)術(shù)后恢復(fù)情況等。結(jié)果:1、CSP組與對(duì)照組年齡的比較CSP組中患者的剖宮產(chǎn)年齡及發(fā)病年齡較為集中,與對(duì)照組相比,兩組在年齡分布上不存在統(tǒng)計(jì)學(xué)差異(P0.05);2、CSP組與對(duì)照組全身情況的比較CSP的發(fā)病與剖宮產(chǎn)術(shù)前非孕期體重指數(shù)、CSP發(fā)病時(shí)體重指數(shù)、剖宮產(chǎn)術(shù)后、CSP發(fā)病時(shí)貧血情況、慢性病史、妊娠期合并癥、盆腹腔手術(shù)無相關(guān)性。兩組數(shù)據(jù)差異不顯著(P0.05);3、CSP組與對(duì)照組子宮位置的比較CSP組后傾子宮10例(19.6%),與對(duì)照組相比,兩組數(shù)據(jù)的差異顯著(P0.05);4、CSP組與對(duì)照組臨床癥狀的比較CSP組在停經(jīng)早期出現(xiàn)腹部疼痛和(或)流血癥狀的有39例(76.5%),高于對(duì)照組高,兩組數(shù)據(jù)的差異顯著(P0.05);5、CSP組與對(duì)照組孕產(chǎn)次的比較CSP組總孕次≥ 3次45例(88.24%),CSP組剖宮產(chǎn)術(shù)≥2次12例(25.49%),人工流產(chǎn)數(shù)≥ 2次26例(50.98%),術(shù)后人工流產(chǎn)數(shù)≥ 2次11例(21.57%),均高于對(duì)照組,兩組之間有顯著性差異(P0.05);術(shù)前人工流產(chǎn)≥ 2次5例(9.8%),兩組差異不顯著(P0.05);6、CSP組與對(duì)照組距前次剖宮產(chǎn)間隔時(shí)間的比較CSP組距上次剖宮產(chǎn)時(shí)間多集中在24-96個(gè)月(2-8年),與對(duì)照組相比,差異無統(tǒng)計(jì)學(xué)意義(P0.05);7、CSP組與對(duì)照組剖宮產(chǎn)情況比較CSP組術(shù)前有胎膜早破者10例(19.6%),與對(duì)照組相比,差異不顯著(P0.05);因陰道試產(chǎn)失敗后行剖宮產(chǎn)者5例(9.8%),其中4例(7.8%)因產(chǎn)程異常行剖宮產(chǎn)術(shù),均低于對(duì)照組,差別顯著(P0.05);因臀位行剖宮產(chǎn)的有13例(25.49%)高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);因羊水過少、巨大兒、無指征剖宮產(chǎn)、妊娠期高血壓等行剖宮產(chǎn)術(shù)者與對(duì)照組相比,差別不顯著(P0.05);8、CSP組與對(duì)照組在術(shù)后發(fā)熱情況的比較CSP組有2例(3.92%)出現(xiàn)剖宮產(chǎn)術(shù)后發(fā)熱,與對(duì)照組相比,差別不顯著(P0.05);結(jié)論:1、多數(shù)CSP患者在孕早期可出現(xiàn)腹痛和(或)陰道流血等臨床癥狀。2、子宮后傾是CSP發(fā)病的相關(guān)因素。3、多次剖宮產(chǎn)、人工流產(chǎn),尤其是剖宮產(chǎn)術(shù)后再人流術(shù)是CSP發(fā)病的相關(guān)因素。4、臀位、無陰道試產(chǎn)過程的剖宮產(chǎn)是CSP發(fā)病的相關(guān)因素。
[Abstract]:Objective: to analyze the age of onset, systemic factors, cesarean section, uterine incision suture and postoperative recovery in CSP (Caesarean scar pregnancy, patients with cesarean scar pregnancy, and to explore the influencing factors of CSP. To provide theoretical basis for reducing and preventing the occurrence of CSP. Methods: from January 2008 to October 2016, 51 patients with CSP were selected as experimental group (CSP group) and 59 cases with normal pregnancy position after cesarean section as control group. The clinical data of the two groups were analyzed retrospectively, including age, systemic condition (body mass index, anemia, history of chronic disease, history of pelvic and abdominal surgery, etc.), location of uterus and cesarean section (cause of cesarean section). The history of pregnancy (total pregnancy, induced abortion, cesarean section, etc.), the method of incision suture and the time from the previous cesarean section, the recovery of cesarean section, etc. Results compared with the control group, the age of cesarean section and the age of onset in the CSP group were higher than those in the control group, and compared with the control group, the age of cesarean section in the CSP group was higher than that in the control group. There was no significant difference in age distribution between the two groups (P0.05). There was no significant difference in the body mass index between the CSP group and the control group (P0.05). The body mass index (BMI) during the onset of CSP before and after cesarean section, the anemia during the onset of CSP after cesarean section, the history of chronic disease, and the body mass index (BMI) before and after cesarean section were not significantly different between the two groups. Complications during pregnancy, pelvic abdominal surgery has no correlation. There was no significant difference between the two groups (P0.05) the position of uterus in CSP group and control group was not significant; 10 cases (19.6%) of retroversion uterus in CSP group were compared with those in control group. The difference between the two groups was significant (P0.05) the clinical symptoms of the CSP group and the control group were significantly higher than that of the control group, and 39 cases (76.5%) of the CSP group had abdominal pain and / or bleeding at the early stage of menopause, which was higher than that in the control group. There was a significant difference between the two groups (P0.05) the total pregnancy times 鈮，

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