679例輸卵管妊娠治療方案的臨床分析
發(fā)布時間：2018-12-17 06:02
【摘要】：背景與目的輸卵管妊娠(tubal pregnancy)是指受精卵在輸卵管部位著床,它是異位妊娠中最常見的一種,發(fā)生率約占95%。輸卵管妊娠好發(fā)于生育期的女性,是嚴(yán)重威脅育齡期女性生育力和生命的常見病之一。在臨床上,輸卵管妊娠是一種發(fā)病原因不明確,治療方案并不完全統(tǒng)一的疾病,臨床工作者們從未停止過對它的研究。臨床中,常通過對女性的血βHCG值和彩超等檢查結(jié)果來診斷輸卵管妊娠。血βHCG是胚胎滋養(yǎng)細胞合成分泌的,可在一定程度上反映滋養(yǎng)細胞的活性。臨床上輸卵管妊娠的治療,主要包括藥物治療和手術(shù)治療,藥物治療主要是應(yīng)用化療藥物甲氨蝶呤來抑制滋養(yǎng)細胞的增生促使胚胎死亡,從而達到治愈;手術(shù)治療主要是通過輸卵管妊娠組織的清除或者患側(cè)輸卵管的切除,而治愈該種疾病。本研究通過對治療前血βHCG的變化趨勢與治療結(jié)果的分析,從而總結(jié)對輸卵管妊娠這一疾病的臨床治療經(jīng)驗。材料與方法材料回顧自2012年1月至2016年1月在鄭州大學(xué)第二附屬醫(yī)院診治的679例輸卵管妊娠的患者的臨床資料進行分析。方法統(tǒng)計所有患者的一般資料:年齡、孕次、產(chǎn)次、停經(jīng)時間、陰道出血時間、住院時間及附件區(qū)包塊直徑的大小、治療前血βHCG濃度的大小。依據(jù)患者采用的治療方案不同,將679例患者,分為藥物治療組(A組)265例,其中單次化療方案的為156例,連續(xù)化療方案的為109例;手術(shù)治療組(B組)414例,行保守手術(shù)的為272例,根治性手術(shù)的為142例;依據(jù)患者治療前血βHCG濃度的變化趨勢,分為上升組(1組)285例,下降組(2組)188例。A組中,呈上升趨勢的A1組有100例,呈下降趨勢的A2組有102例。分析組間的治療結(jié)果。統(tǒng)計學(xué)方法應(yīng)用SPSS17.0處理和分析相關(guān)數(shù)據(jù),計量資料用均數(shù)±標(biāo)準(zhǔn)差及t檢驗描述,計數(shù)資料用卡方檢驗及單因素方差分析,P0.05為有統(tǒng)計學(xué)差異。結(jié)果679例患者中,265例行藥物保守治療,414例行手術(shù)治療。1、一般資料在年齡、孕產(chǎn)次、停經(jīng)時間、陰道出血時間上,A組和B組是無統(tǒng)計學(xué)差異的(P0.05);而A組的住院時間長于B組;A組的附件區(qū)包塊直徑小于B組,A組的治療前血βHCG值小于B組,均有統(tǒng)計學(xué)差異。2、病例資料(1)A組中,單次化療方案和連續(xù)化療方案的治療成功率分別為87.18%、91.74%,無統(tǒng)計學(xué)差異(P0.05);(2)在輸卵管妊娠的治療上,1組的治療成功率為88.77%,2組為98.79%,有統(tǒng)計學(xué)差異(P=0.000.05);A1組與A2組的治療成功率分別為72.00%,99.02%,有統(tǒng)計學(xué)差異(P=0.000.05)。結(jié)論1、對于生命體征平穩(wěn),治療前間隔48小時血βHCG呈上升趨勢且上升幅度≥5%的患者,藥物保守治療失敗率較高;2、對于生命體征平穩(wěn),治療前間隔48小時血βHCG呈下降趨勢且下降幅度≥5%的患者,藥物保守治療成功率較高。
[Abstract]:Background & objective (tubal pregnancy) refers to the implantation of fertilized eggs in the oviduct. It is the most common ectopic pregnancy, the incidence of which accounts for 95%. Fallopian tube pregnancy is one of the common diseases that threaten the fertility and life of women of reproductive age. In clinic, tubal pregnancy is a kind of disease which is not clear about the cause and the treatment plan is not completely unified. The clinical workers have never stopped studying it. In clinic, tubal pregnancy is often diagnosed by blood 尾-HCG and color Doppler ultrasound. Serum 尾-HCG is synthesized and secreted by embryonic trophoblast, which can reflect the activity of trophoblast to some extent. The clinical treatment of tubal pregnancy mainly includes drug treatment and surgical treatment. The drug therapy mainly uses chemotherapy drug methotrexate to inhibit the proliferation of trophoblastic cells to promote embryo death and thus to achieve cure. Surgical treatment is mainly through the removal of tubal pregnancy tissue or resection of the affected side of the fallopian tube, and cure the disease. In this study, the clinical experience in the treatment of tubal pregnancy was summarized by analyzing the change trend and treatment results of serum 尾 HCG before treatment. Materials and methods the clinical data of 679 cases of tubal pregnancy treated in the second affiliated Hospital of Zhengzhou University from January 2012 to January 2016 were analyzed. Methods the general data of all patients were analyzed: age, pregnancy, labor, menopause time, vaginal bleeding time, hospitalization time, diameter of adnexal mass, and serum 尾 HCG concentration before treatment. According to the different treatment regimen, 679 patients were divided into two groups: group A (n = 265), single chemotherapy regimen (n = 156) and continuous chemotherapy regimen (n = 109). There were 414 cases in group B, 272 cases underwent conservative operation and 142 cases underwent radical operation. According to the change trend of serum 尾 HCG before treatment, 285 patients were divided into two groups: group 1 (n = 285) and group A (n = 188). In group A, there were 100 cases in A 1 group and 102 cases in A 2 group. The results of treatment between groups were analyzed. Statistical methods were used to process and analyze the relevant data by SPSS17.0, the measurement data were described by mean 鹵standard deviation and t test, and the counting data were described by chi-square test and single factor analysis of variance (P0.05). Results among 679 patients, 265 cases received conservative drug therapy and 414 cases underwent surgical treatment. 1. There was no significant difference in age, pregnancy and delivery, menopause time and vaginal bleeding time between group A and group B (P0.05). The length of hospitalization in group A was longer than that in group B; The diameter of adnexal mass in group A was smaller than that in group B, and the serum 尾 HCG value of group A was smaller than that of group B (P < 0.05). There was statistical difference between group A and group A. the success rates of single chemotherapy regimen and continuous chemotherapy regimen were 87.18 in group A, respectively. 91.74, there was no statistical difference (P0.05); (2) in the treatment of tubal pregnancy, the success rate of treatment in group 1 was 88.777.The success rate of group 2 was 98.79 (P < 0.000.05). The successful rate of treatment in group A1 and group A2 was 72.00 and 99.02, respectively (P < 0.000.05). Conclusion (1) for patients with stable vital signs and 48 hours before treatment, the failure rate of conservative drug therapy was higher than that of patients whose serum 尾 HCG increased by more than 5% at the interval of 48 hours before treatment. 2. The success rate of conservative treatment was higher in patients with stable vital signs and decreased serum 尾 HCG at 48 hours before treatment and the extent of decline was more than 5%.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.22
本文編號：2383776
[Abstract]:Background & objective (tubal pregnancy) refers to the implantation of fertilized eggs in the oviduct. It is the most common ectopic pregnancy, the incidence of which accounts for 95%. Fallopian tube pregnancy is one of the common diseases that threaten the fertility and life of women of reproductive age. In clinic, tubal pregnancy is a kind of disease which is not clear about the cause and the treatment plan is not completely unified. The clinical workers have never stopped studying it. In clinic, tubal pregnancy is often diagnosed by blood 尾-HCG and color Doppler ultrasound. Serum 尾-HCG is synthesized and secreted by embryonic trophoblast, which can reflect the activity of trophoblast to some extent. The clinical treatment of tubal pregnancy mainly includes drug treatment and surgical treatment. The drug therapy mainly uses chemotherapy drug methotrexate to inhibit the proliferation of trophoblastic cells to promote embryo death and thus to achieve cure. Surgical treatment is mainly through the removal of tubal pregnancy tissue or resection of the affected side of the fallopian tube, and cure the disease. In this study, the clinical experience in the treatment of tubal pregnancy was summarized by analyzing the change trend and treatment results of serum 尾 HCG before treatment. Materials and methods the clinical data of 679 cases of tubal pregnancy treated in the second affiliated Hospital of Zhengzhou University from January 2012 to January 2016 were analyzed. Methods the general data of all patients were analyzed: age, pregnancy, labor, menopause time, vaginal bleeding time, hospitalization time, diameter of adnexal mass, and serum 尾 HCG concentration before treatment. According to the different treatment regimen, 679 patients were divided into two groups: group A (n = 265), single chemotherapy regimen (n = 156) and continuous chemotherapy regimen (n = 109). There were 414 cases in group B, 272 cases underwent conservative operation and 142 cases underwent radical operation. According to the change trend of serum 尾 HCG before treatment, 285 patients were divided into two groups: group 1 (n = 285) and group A (n = 188). In group A, there were 100 cases in A 1 group and 102 cases in A 2 group. The results of treatment between groups were analyzed. Statistical methods were used to process and analyze the relevant data by SPSS17.0, the measurement data were described by mean 鹵standard deviation and t test, and the counting data were described by chi-square test and single factor analysis of variance (P0.05). Results among 679 patients, 265 cases received conservative drug therapy and 414 cases underwent surgical treatment. 1. There was no significant difference in age, pregnancy and delivery, menopause time and vaginal bleeding time between group A and group B (P0.05). The length of hospitalization in group A was longer than that in group B; The diameter of adnexal mass in group A was smaller than that in group B, and the serum 尾 HCG value of group A was smaller than that of group B (P < 0.05). There was statistical difference between group A and group A. the success rates of single chemotherapy regimen and continuous chemotherapy regimen were 87.18 in group A, respectively. 91.74, there was no statistical difference (P0.05); (2) in the treatment of tubal pregnancy, the success rate of treatment in group 1 was 88.777.The success rate of group 2 was 98.79 (P < 0.000.05). The successful rate of treatment in group A1 and group A2 was 72.00 and 99.02, respectively (P < 0.000.05). Conclusion (1) for patients with stable vital signs and 48 hours before treatment, the failure rate of conservative drug therapy was higher than that of patients whose serum 尾 HCG increased by more than 5% at the interval of 48 hours before treatment. 2. The success rate of conservative treatment was higher in patients with stable vital signs and decreased serum 尾 HCG at 48 hours before treatment and the extent of decline was more than 5%.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.22
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