雙側(cè)子宮動脈栓塞術(shù)治療胎盤植入臨床分析
發(fā)布時(shí)間：2018-11-02 10:03
【摘要】：研究背景及意義: 胎盤植入(placenta implantation，PI)屬于妊娠相關(guān)出血性疾病的范疇，近年來發(fā)生率和嚴(yán)重性不斷上升。為防止難治性出血這種潛在的并發(fā)癥，除了圍產(chǎn)期子宮切除外，子宮動脈栓塞術(shù)是可以作為代替外科手術(shù)的一種新方法，已證明其對控制其他治療無反應(yīng)的產(chǎn)后出血的成功率超過90%。本研究分析胎盤植入的臨床特點(diǎn)，探討子宮動脈栓塞術(shù)治療胎盤植入的臨床療效，產(chǎn)生的并發(fā)癥和對未來生育的影響。 目的: 探討我院收治的胎盤植入患者臨床特點(diǎn)和診斷方法，并行子宮動脈栓塞術(shù)治療的療效、并發(fā)癥。 方法: 1．收集一般資料：收集我科2006年1月至2011年12月共收治的胎盤植入患者共計(jì)110例，其中晚期妊娠患者80例，并根據(jù)治療方法將其分為三組：①保守治療組12例：采用藥物(主要是米非司酮)保守治療；②子宮動脈栓塞(uterine arteryembolization，UAE)組40例，采用雙側(cè)子宮動脈栓塞術(shù)治療；③子宮切除組9例，經(jīng)外科手術(shù)切除子宮。記錄患者年齡、孕產(chǎn)次、孕周、既往史、診斷及治療方法。 2．觀察和記錄的數(shù)據(jù)和指標(biāo)：三組的臨床結(jié)局、栓塞治療有效率(如出血減少或停止、月經(jīng)復(fù)潮或再次妊娠)和失敗率(如二次栓塞、子宮切除或產(chǎn)婦死亡)，并比較三組患者的出血量、輸血量、住院時(shí)間、手術(shù)時(shí)間、胎盤排出和月經(jīng)復(fù)潮時(shí)間。由電話隨訪得到患者后續(xù)的關(guān)于月經(jīng)和生育的信息，記錄在臨床隨訪的1年期間，正常月經(jīng)復(fù)潮情況和再次妊娠情況。 3．統(tǒng)計(jì)學(xué)分析：應(yīng)用統(tǒng)計(jì)學(xué)軟件SPSS19.0進(jìn)行統(tǒng)計(jì)分析，計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差（x±s）表示，行t檢驗(yàn)或方差分析，P＜0.05表示差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果: 1．胎盤植入的發(fā)生與患者的剖宮產(chǎn)史(38.18%)、刮宮史(92.73%)等子宮手術(shù)史、前置胎盤(32.73%)、年齡(30.00%)等因素有關(guān)。診斷依靠臨床表現(xiàn)、彩超檢查、病理檢查三項(xiàng)依據(jù)。 2．子宮動脈栓塞組、子宮切除組、保守治療組的年齡、孕周、孕次差異均無統(tǒng)計(jì)學(xué)意義(P＞0.05)。 3．經(jīng)子宮動脈栓塞術(shù)后38例成功止血，有2例未能止血而行子宮切除術(shù)。栓塞術(shù)后未出現(xiàn)器官局部缺血壞死、神經(jīng)損傷等嚴(yán)重并發(fā)癥，發(fā)熱、下腹痛為常見并發(fā)癥。 4．子宮動脈栓塞組、子宮切除組、保守治療組的出血和輸血量、手術(shù)時(shí)間、住院天數(shù)的差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。 5.對UAE組患者進(jìn)行為期1年的隨訪，除9例失訪病例，其余患者在隨訪時(shí)間內(nèi)恢復(fù)正常月經(jīng)，并有2例再次妊娠者。 結(jié)論: 1.胎盤植入發(fā)生率隨時(shí)間有增加趨勢。胎盤植入的診斷以臨床診斷和彩超診斷為主。 2.采用雙側(cè)子宮動脈栓塞術(shù)治療胎盤植入，，其術(shù)前準(zhǔn)備時(shí)間和手術(shù)時(shí)間均短，出血控制迅速且并發(fā)癥少，保留了患者的子宮，提高了患者的生活質(zhì)量。
[Abstract]:Background and significance: placenta accreta (placenta implantation,PI) belongs to the category of pregnancy-associated hemorrhagic diseases. In order to prevent the potential complications of intractable hemorrhage, uterine artery embolization is a new method to replace surgical procedures, in addition to perinatal hysterectomy. It has been proven to be more than 90% successful in controlling postpartum hemorrhage that does not respond to other treatments. This study analyzed the clinical characteristics of placenta accreta and discussed the clinical effect of uterine artery embolization in the treatment of placenta accreta, its complications and its influence on future fertility. Objective: to investigate the clinical features and diagnostic methods of placenta accreta in our hospital, the curative effect and complication of uterine artery embolization. Methods: 1. Collecting general data: from January 2006 to December 2011, 110 patients with placenta accreta were admitted to our department, including 80 cases of late pregnancy. The patients were divided into three groups according to the treatment method: (1) the conservative treatment group (12 cases) was treated with medicine (mainly mifepristone); 2uterine artery embolization (uterine arteryembolization,UAE) group (n = 40), bilateral uterine artery embolization group (n = 40), hysterectomy group (n = 9), hysterectomy group (n = 9). The patient's age, pregnancy, gestational age, past history, diagnosis and treatment were recorded. 2. Data and indicators observed and recorded: clinical outcomes of the three groups, effective rate of embolization (e.g. reduction or cessation of bleeding, menorrhagia or re-pregnancy) and failure rate (e.g. secondary embolism, hysterectomy or maternal death), The blood loss, blood transfusion, hospital stay, operative time, placental discharge and menstrual resuscitation were compared among the three groups. The follow-up information on menstruation and fertility was obtained by telephone follow-up, and the normal menstrual regurgitation and re-pregnancy were recorded during the 1-year follow-up period. 3. Statistical analysis: statistical software SPSS19.0 was used for statistical analysis. The measurement data were expressed as mean 鹵standard deviation (x 鹵s), t test or analysis of variance (P < 0. 05). Results: 1. The occurrence of placenta accreta was related to the history of cesarean section (38.18%), uterine curettage (92.73%), placenta previa (32.73%) and age (30.00%). The diagnosis depends on clinical manifestation, color ultrasonography and pathological examination. 2. There was no significant difference in age, gestational age and pregnancy in uterine artery embolization group, hysterectomy group and conservative treatment group (P > 0.05). 3. Successful hemostasis was achieved in 38 cases after transuterine artery embolization, and hysterectomy was performed in 2 cases without hemostasis. There were no serious complications such as organ necrosis and nerve injury after embolization. Fever and lower abdominal pain were common complications. 4. There were significant differences among uterine artery embolism group, hysterectomy group and conservative treatment group in the amount of bleeding and blood transfusion, operation time and hospital stay (P < 0.05). 5. The patients in UAE group were followed up for one year. Except for 9 cases of lost visit, the other patients returned to normal menstruation during the follow-up period, and 2 cases were pregnant again. Conclusion: 1. The incidence of placenta accreta increased with time. The diagnosis of placenta accreta mainly consists of clinical diagnosis and color Doppler ultrasound diagnosis. 2. Using bilateral uterine artery embolization to treat placenta accreta, the preoperative preparation time and operation time are short, bleeding is controlled quickly and complications are less, the uterus of the patient is preserved and the quality of life of the patient is improved.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.2
本文編號：2305712
[Abstract]:Background and significance: placenta accreta (placenta implantation,PI) belongs to the category of pregnancy-associated hemorrhagic diseases. In order to prevent the potential complications of intractable hemorrhage, uterine artery embolization is a new method to replace surgical procedures, in addition to perinatal hysterectomy. It has been proven to be more than 90% successful in controlling postpartum hemorrhage that does not respond to other treatments. This study analyzed the clinical characteristics of placenta accreta and discussed the clinical effect of uterine artery embolization in the treatment of placenta accreta, its complications and its influence on future fertility. Objective: to investigate the clinical features and diagnostic methods of placenta accreta in our hospital, the curative effect and complication of uterine artery embolization. Methods: 1. Collecting general data: from January 2006 to December 2011, 110 patients with placenta accreta were admitted to our department, including 80 cases of late pregnancy. The patients were divided into three groups according to the treatment method: (1) the conservative treatment group (12 cases) was treated with medicine (mainly mifepristone); 2uterine artery embolization (uterine arteryembolization,UAE) group (n = 40), bilateral uterine artery embolization group (n = 40), hysterectomy group (n = 9), hysterectomy group (n = 9). The patient's age, pregnancy, gestational age, past history, diagnosis and treatment were recorded. 2. Data and indicators observed and recorded: clinical outcomes of the three groups, effective rate of embolization (e.g. reduction or cessation of bleeding, menorrhagia or re-pregnancy) and failure rate (e.g. secondary embolism, hysterectomy or maternal death), The blood loss, blood transfusion, hospital stay, operative time, placental discharge and menstrual resuscitation were compared among the three groups. The follow-up information on menstruation and fertility was obtained by telephone follow-up, and the normal menstrual regurgitation and re-pregnancy were recorded during the 1-year follow-up period. 3. Statistical analysis: statistical software SPSS19.0 was used for statistical analysis. The measurement data were expressed as mean 鹵standard deviation (x 鹵s), t test or analysis of variance (P < 0. 05). Results: 1. The occurrence of placenta accreta was related to the history of cesarean section (38.18%), uterine curettage (92.73%), placenta previa (32.73%) and age (30.00%). The diagnosis depends on clinical manifestation, color ultrasonography and pathological examination. 2. There was no significant difference in age, gestational age and pregnancy in uterine artery embolization group, hysterectomy group and conservative treatment group (P > 0.05). 3. Successful hemostasis was achieved in 38 cases after transuterine artery embolization, and hysterectomy was performed in 2 cases without hemostasis. There were no serious complications such as organ necrosis and nerve injury after embolization. Fever and lower abdominal pain were common complications. 4. There were significant differences among uterine artery embolism group, hysterectomy group and conservative treatment group in the amount of bleeding and blood transfusion, operation time and hospital stay (P < 0.05). 5. The patients in UAE group were followed up for one year. Except for 9 cases of lost visit, the other patients returned to normal menstruation during the follow-up period, and 2 cases were pregnant again. Conclusion: 1. The incidence of placenta accreta increased with time. The diagnosis of placenta accreta mainly consists of clinical diagnosis and color Doppler ultrasound diagnosis. 2. Using bilateral uterine artery embolization to treat placenta accreta, the preoperative preparation time and operation time are short, bleeding is controlled quickly and complications are less, the uterus of the patient is preserved and the quality of life of the patient is improved.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.2
【參考文獻(xiàn)】
相關(guān)期刊論文 前6條
1 連蕓;楊紅;;胎盤部分植入保全子宮治療12例[J];第四軍醫(yī)大學(xué)學(xué)報(bào);2008年16期
2 李嵐;楊鷹;;雙側(cè)子宮動脈栓塞術(shù)治療晚期妊娠胎盤植入患者臨床分析[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2014年10期
3 田錦林;杜亞輝;王偉;李云松;李春雷;陳碩飛;;選擇性子宮動脈栓塞治療產(chǎn)后出血[J];中國介入影像與治療學(xué);2011年01期
4 陳曉紅;郭金蓮;;結(jié)晶天花粉蛋白保守治療胎盤植入22例臨床分析[J];臨床合理用藥雜志;2011年18期
5 楊明菊;;生化湯治療完全性胎盤植入1例[J];新中醫(yī);2011年01期
6 丁依玲,彭梅;3種方法保守治療胎盤植入19例的比較[J];中國婦幼保健;2005年19期
本文編號：2305712
本文鏈接：http://sikaile.net/yixuelunwen/fuchankeerkelunwen/2305712.html
最近更新
教材專著
