剖宮產(chǎn)瘢痕妊娠臨床病例分析
發(fā)布時間：2018-09-16 21:59
【摘要】：目的:回顧性研究剖宮產(chǎn)瘢痕妊娠的相關因素,為剖宮產(chǎn)瘢痕妊娠的預防提供理論依據(jù),同時分析剖宮產(chǎn)瘢痕妊娠不同治療方案的優(yōu)缺點及其以后的妊娠結局,為臨床治療剖宮產(chǎn)瘢痕妊娠的選擇提供理論支持。方法:本研究收集我院2008年1月至2016年2月因剖宮產(chǎn)瘢痕妊娠(I型及II型)住院治療并取得良好治療效果的患者共92人作為研究對象。按照不同治療方案患者分為保守治療組、B超或?qū)m腔鏡下清宮組及子宮動脈超選擇性栓塞術術后清宮組,分別統(tǒng)計三種不同治療方案患者平均住院天數(shù)、治療花費、血HCG轉(zhuǎn)陰時間,選擇性價比最高的治療方案。挑選有生育要求的患者,隨訪其正常性生活未避孕1年的妊娠結局,包括正常妊娠、再次異位妊娠及不孕。同時電話隨訪患者填寫危險因素調(diào)查表,并隨機挑選同期剖宮產(chǎn)后再次正常妊娠婦女100例作為危險因素調(diào)查對照組。數(shù)據(jù)使用spss19.0軟件分析,計量資料采用均數(shù)及標準差表示;計數(shù)資料采用卡方檢驗或連續(xù)校正卡方檢驗統(tǒng)計處理,剖宮產(chǎn)瘢痕妊娠相關單因素分析使用卡方檢驗,多因素統(tǒng)計依據(jù)logistic回歸檢驗剖宮產(chǎn)瘢痕妊娠發(fā)病的危險因素。結果:1.剖宮產(chǎn)瘢痕妊娠發(fā)病年齡主要集中在30-39歲,共62人。2.剖宮產(chǎn)瘢痕妊娠相關單因素統(tǒng)計分析:有統(tǒng)計學意義(P0.05)的有人工流產(chǎn)史、前置胎盤、人工剝離胎盤、前次剖宮產(chǎn)胎先露的部位、盆腔炎性疾病、盆腹腔手術史,無統(tǒng)計學意義(P0.05)的有民族、吸煙、酗酒、月經(jīng)紊亂、子宮肌瘤、宮腔粘連、子宮內(nèi)膜息肉、胎盤早剝、剖宮產(chǎn)的次數(shù)、距前次剖宮產(chǎn)的時間、異位妊娠史、卵巢腫瘤、輔助生殖技術、宮內(nèi)節(jié)育器及口服避孕藥。3.多因素統(tǒng)計分析:人工流產(chǎn)史、前次剖宮產(chǎn)胎先露的部位、前置胎盤、人工剝離胎盤是剖宮產(chǎn)瘢痕妊娠的獨立危險因素,其OR值為4.953、3.257、2.826、2.729。4.治療前血HCG:保守治療組11891.47±8164.16MIU/ml、B超或?qū)m腔鏡下清宮組29150.09±9953.03MIU/ml、子宮動脈超選擇性栓塞術術后清宮組32986.72±10987.21MIU/ml,F=37.848,P0.05,三組間有差別,行兩兩比較后,保守治療分別與B超或?qū)m腔鏡下清宮組和子宮動脈超選擇性栓塞術術后清宮組有差異,但尚不能認為B超或?qū)m腔鏡下清宮組和子宮動脈超選擇性栓塞術術后清宮組有差異。5.三組間治療前病灶直徑、病灶距子宮漿膜層的距離無統(tǒng)計學差異(P0.05)。6.三組間住院天數(shù)無統(tǒng)計學差異(P0.05)。7.花費:保守治療組4191.80±428.14元、B超或?qū)m腔鏡下清宮組7363.2±1522.46元、子宮動脈超選擇性栓塞術術后清宮組12930.06±1172.72元,F=297.88,P0.05,三組間有差別,兩兩比較后,三組間平均花費均有差別。8.血HCG轉(zhuǎn)陰時間:保守治療組29.40±5.75天、B超或?qū)m腔鏡下清宮組21.57±8.28天、子宮動脈超選擇性栓塞術術后清宮組23.00±4.04天,F=15.711,P0.05,認為三組間有差別,兩兩比較后,認為保守治療組分別與B超或?qū)m腔鏡下清宮組和子宮動脈超選擇性栓塞術術后清宮組有差別,但尚不能認為B超或?qū)m腔鏡下清宮組和子宮動脈超選擇性栓塞術術后清宮組有差別。9.有生育要求的患者中,保守治療組、B超或?qū)m腔鏡下清宮組、子宮動脈超選擇性栓塞術術后清宮組的正常妊娠率分別為:70.59%、40.91%、70.00%;再次異位妊娠的發(fā)生率分別為:11.76%、4.55%、20.00%;不孕率分別為:17.65%、54.55%、10.00%。三組間正常妊娠及再次異位妊娠率差異無統(tǒng)計學意義,但在不孕率上,B超或?qū)m腔鏡下清宮組不孕率高于其他兩組。結論:1.剖宮產(chǎn)瘢痕妊娠發(fā)病年齡主要集中在30-39歲,對于該年齡段有剖宮產(chǎn)史的急腹癥患者,需警惕剖宮產(chǎn)瘢痕妊娠的發(fā)生。2.剖宮產(chǎn)瘢痕妊娠的發(fā)生與人工流產(chǎn)史、前置胎盤、人工剝離胎盤、前次剖宮產(chǎn)胎先露的部位、盆腔炎性疾病、盆腹腔手術史有關。3.保守治療性價比最高。4.有生育要求、血HCG較高且病情較重的患者,可選擇子宮動脈超選擇性栓塞術術后清宮。
[Abstract]:Objective: To retrospectively study the related factors of cesarean scar pregnancy, and to provide theoretical basis for the prevention of cesarean scar pregnancy. At the same time, to analyze the advantages and disadvantages of different treatment schemes for cesarean scar pregnancy and their subsequent pregnancy outcomes. Ninety-two patients with cesarean scar pregnancy (type I and type II) who were hospitalized from January 1, 2006 to February 26, 2016 and received good results were divided into conservative treatment group, ultrasonic or hysteroscopic uterine clearance group and uterine artery superselective embolization group. The average hospitalization days, treatment costs, blood HCG negative time, and the most selective treatment regimen were selected. The patients with fertility requirements were followed up for 1 year without contraception, including normal pregnancy, recurrent ectopic pregnancy and infertility. 100 normal pregnant women after cesarean section were selected as the control group. The data were analyzed by SPSS 19.0 software, and the measurement data were expressed by mean and standard deviation. The counting data were analyzed by chi-square test or continuous correction chi-square test. The single factor analysis related to cesarean scar pregnancy was performed by chi-square test and multi-factor system. Results: 1. The incidence of cesarean scar pregnancy was mainly concentrated in the age of 30-39 years, a total of 62 people. 2. Single factor statistical analysis of cesarean scar pregnancy: there were statistically significant (P 0.05) history of induced abortion, placenta previa, artificial stripping placenta, cesarean section placenta previa. There were no significant differences in the position of exposure, pelvic inflammatory disease, history of pelvic and abdominal surgery (P 0.05), smoking, alcoholism, menstrual disorders, uterine fibroids, uterine adhesion, endometrial polyps, placental abruption, the number of cesarean section, the time before cesarean section, ectopic pregnancy, ovarian tumors, assisted reproductive technology, intrauterine device and oral contraception. 3. Multivariate statistical analysis: The history of induced abortion, the location of anterior cesarean section, placenta previa and artificially stripped placenta were the independent risk factors of cesarean scar pregnancy. The OR value was 4.953, 3.257, 2.826, 2.729.4. The blood HCG before treatment was 11891.47 [8164.16MIU/ml] in the conservative treatment group, 29150.09 [9953.03MIU/ml] in the ultrasound or hysteroscopy group. After superselective uterine artery embolization, the uterine clearance group was 32986.72 + 10987.21 MIU/ml, F = 37.848, P 0.05. There were differences among the three groups. After two-to-two comparisons, the conservative treatment was different from the B ultrasound or hysteroscopic uterine clearance group and the uterine artery clearance group after superselective uterine artery embolization. There was no significant difference in the diameter of lesions and the distance between lesions and the serosa between the three groups (P 0.05). 6. There was no significant difference in the length of hospital stay among the three groups (P 0.05). 7. Cost: 4191.80 428.14 yuan in the conservative treatment group, 7363.2 1522.46 yuan in the B ultrasound or hysteroscopic clearance group, and 7363.2 1522.46 yuan in the uterine artery superselective treatment group. After sex embolization, the clear uterus group was 12930.06+1172.72 yuan, F=297.88, P 0.05, there were differences among the three groups. After two comparisons, the average cost between the three groups was different. 8. Blood HCG negative time: conservative treatment group 29.40+5.75 days, B ultrasound or hysteroscopy clear uterus group 21.57+8.28 days, uterine artery superselective embolization clear uterus group 23.00+4.04 days, F=15.711, P = 15.711, P 0.05, that there are differences between the three groups, after two comparisons, that conservative treatment group and B ultrasound or hysteroscopy uterine clearance group and uterine artery superselective embolization after uterine clearance group were different, but can not be considered B ultrasound or hysteroscopy uterine clearance group and uterine artery superselective embolization after uterine clearance group have differences. 9. fertility requirements of patients In the conservative treatment group, the normal pregnancy rates were 70.59%, 40.91% and 70.00% in the B ultrasound or hysteroscopy group, respectively; the recurrence rates of ectopic pregnancy were 11.76%, 4.55% and 20.00%, and the infertility rates were 17.65%, 54.55% and 10.00% respectively. Conclusion: 1. The incidence of cesarean scar pregnancy is mainly concentrated in 30-39 years old. For the patients with acute abdomen who have a history of cesarean section, it is necessary to be alert to the occurrence of cesarean scar pregnancy. 2. The occurrence of cesarean scar pregnancy and induced abortion. History, placenta previa, artificially stripped placenta, placenta previa site of cesarean section, pelvic inflammatory disease, history of pelvic and abdominal surgery related. 3. Conservative treatment of the highest cost-effectiveness. 4. Fertility requirements, blood HCG higher and severely ill patients, can choose uterine artery superselective embolization after uterine clearance.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.22
本文編號：2244944
[Abstract]:Objective: To retrospectively study the related factors of cesarean scar pregnancy, and to provide theoretical basis for the prevention of cesarean scar pregnancy. At the same time, to analyze the advantages and disadvantages of different treatment schemes for cesarean scar pregnancy and their subsequent pregnancy outcomes. Ninety-two patients with cesarean scar pregnancy (type I and type II) who were hospitalized from January 1, 2006 to February 26, 2016 and received good results were divided into conservative treatment group, ultrasonic or hysteroscopic uterine clearance group and uterine artery superselective embolization group. The average hospitalization days, treatment costs, blood HCG negative time, and the most selective treatment regimen were selected. The patients with fertility requirements were followed up for 1 year without contraception, including normal pregnancy, recurrent ectopic pregnancy and infertility. 100 normal pregnant women after cesarean section were selected as the control group. The data were analyzed by SPSS 19.0 software, and the measurement data were expressed by mean and standard deviation. The counting data were analyzed by chi-square test or continuous correction chi-square test. The single factor analysis related to cesarean scar pregnancy was performed by chi-square test and multi-factor system. Results: 1. The incidence of cesarean scar pregnancy was mainly concentrated in the age of 30-39 years, a total of 62 people. 2. Single factor statistical analysis of cesarean scar pregnancy: there were statistically significant (P 0.05) history of induced abortion, placenta previa, artificial stripping placenta, cesarean section placenta previa. There were no significant differences in the position of exposure, pelvic inflammatory disease, history of pelvic and abdominal surgery (P 0.05), smoking, alcoholism, menstrual disorders, uterine fibroids, uterine adhesion, endometrial polyps, placental abruption, the number of cesarean section, the time before cesarean section, ectopic pregnancy, ovarian tumors, assisted reproductive technology, intrauterine device and oral contraception. 3. Multivariate statistical analysis: The history of induced abortion, the location of anterior cesarean section, placenta previa and artificially stripped placenta were the independent risk factors of cesarean scar pregnancy. The OR value was 4.953, 3.257, 2.826, 2.729.4. The blood HCG before treatment was 11891.47 [8164.16MIU/ml] in the conservative treatment group, 29150.09 [9953.03MIU/ml] in the ultrasound or hysteroscopy group. After superselective uterine artery embolization, the uterine clearance group was 32986.72 + 10987.21 MIU/ml, F = 37.848, P 0.05. There were differences among the three groups. After two-to-two comparisons, the conservative treatment was different from the B ultrasound or hysteroscopic uterine clearance group and the uterine artery clearance group after superselective uterine artery embolization. There was no significant difference in the diameter of lesions and the distance between lesions and the serosa between the three groups (P 0.05). 6. There was no significant difference in the length of hospital stay among the three groups (P 0.05). 7. Cost: 4191.80 428.14 yuan in the conservative treatment group, 7363.2 1522.46 yuan in the B ultrasound or hysteroscopic clearance group, and 7363.2 1522.46 yuan in the uterine artery superselective treatment group. After sex embolization, the clear uterus group was 12930.06+1172.72 yuan, F=297.88, P 0.05, there were differences among the three groups. After two comparisons, the average cost between the three groups was different. 8. Blood HCG negative time: conservative treatment group 29.40+5.75 days, B ultrasound or hysteroscopy clear uterus group 21.57+8.28 days, uterine artery superselective embolization clear uterus group 23.00+4.04 days, F=15.711, P = 15.711, P 0.05, that there are differences between the three groups, after two comparisons, that conservative treatment group and B ultrasound or hysteroscopy uterine clearance group and uterine artery superselective embolization after uterine clearance group were different, but can not be considered B ultrasound or hysteroscopy uterine clearance group and uterine artery superselective embolization after uterine clearance group have differences. 9. fertility requirements of patients In the conservative treatment group, the normal pregnancy rates were 70.59%, 40.91% and 70.00% in the B ultrasound or hysteroscopy group, respectively; the recurrence rates of ectopic pregnancy were 11.76%, 4.55% and 20.00%, and the infertility rates were 17.65%, 54.55% and 10.00% respectively. Conclusion: 1. The incidence of cesarean scar pregnancy is mainly concentrated in 30-39 years old. For the patients with acute abdomen who have a history of cesarean section, it is necessary to be alert to the occurrence of cesarean scar pregnancy. 2. The occurrence of cesarean scar pregnancy and induced abortion. History, placenta previa, artificially stripped placenta, placenta previa site of cesarean section, pelvic inflammatory disease, history of pelvic and abdominal surgery related. 3. Conservative treatment of the highest cost-effectiveness. 4. Fertility requirements, blood HCG higher and severely ill patients, can choose uterine artery superselective embolization after uterine clearance.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.22
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