【摘要】：目的：探討綜合介入治療輸卵管妊娠的臨床療效和意義。 方法：回顧性分析2009年12月-2013年12月在武漢科技大學(xué)附屬天佑醫(yī)院和湖北省婦幼保健院收治的輸卵管妊娠患者104例，，自愿接受綜合介入治療52例的作為研究組，接受藥物肌肉注射治療的52例作為對(duì)照組。比較兩組患者的平均年齡、停經(jīng)時(shí)間、治療前血β-HCG值和盆腔包塊直徑；觀察治療中動(dòng)脈造影的形態(tài)特征；比較治療后兩組的治愈率、血β-HCG值降至正常的時(shí)間、盆腔包塊吸收的時(shí)間、月經(jīng)恢復(fù)正常的時(shí)間、不良反應(yīng)發(fā)生率；分別監(jiān)測(cè)研究組術(shù)前、術(shù)后三個(gè)月、術(shù)后六個(gè)月E2、LH、FSH水平有無變化；月經(jīng)恢復(fù)正常干凈后第三天做HSG，觀察兩組輸卵管通暢情況。對(duì)結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果：1.兩組患者的平均年齡、停經(jīng)時(shí)間、治療前血β-HCG值和盆腔包塊直徑比較均無統(tǒng)計(jì)學(xué)差異(P0.05)，兩組資料具有可比性。 2.研究組子宮動(dòng)脈造影根據(jù)其形態(tài)大致可分為兩種類型：類型一無明顯征象，類型二實(shí)質(zhì)期可見小片狀絨毛染色。 3.研究組治愈率為96.15%，血β-HCG值降至正常為17.60±6.29天，盆腔包塊吸收時(shí)間為26.98±6.23天，月經(jīng)恢復(fù)正常的時(shí)間為32.64±4.88天，不良反應(yīng)發(fā)生率為6.00%；對(duì)照組治愈率為76.92%，血β-HCG值降至正常為22.75±7.91天，盆腔包塊吸收時(shí)間為30.30±8.23天，月經(jīng)恢復(fù)正常的時(shí)間為34.58±5.82天，不良反應(yīng)發(fā)生率為27.50%。經(jīng)統(tǒng)計(jì)學(xué)分析，兩組治愈率(P0.01)、血β-HCG值降至正常時(shí)間(P0.01)、盆腔包塊吸收時(shí)間(P0.05)、不良反應(yīng)發(fā)生率(P0.01)差異有統(tǒng)計(jì)學(xué)意義,兩組月經(jīng)恢復(fù)正常時(shí)間(P0.05)差異無統(tǒng)計(jì)學(xué)意義。 4.比較研究組術(shù)前、術(shù)后三個(gè)月、術(shù)后六個(gè)月E2、LH、FSH，差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 5.研究組和對(duì)照組治療后輸卵管通暢率分別為92.50%和76.32%，差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論：1、在TP的治療中，綜合介入治療比單劑量藥物治療療效好，恢復(fù)快，不良反應(yīng)少，優(yōu)勢(shì)明顯。 2、子宮動(dòng)脈造影在TP診療中有較高的診療價(jià)值，可與B超檢查和血β-HCG的測(cè)定優(yōu)勢(shì)互補(bǔ)，對(duì)準(zhǔn)確診斷定位和預(yù)測(cè)治療效果有重要意義。 3、綜合介入治療能有效避免和減少TP破裂出血，最大限度的保持輸卵管的完整。 4、運(yùn)用綜合介入治療TP對(duì)卵巢功能無明顯影響。 5、綜合介入治療是一種微創(chuàng)、精準(zhǔn)、安全、有效的治療TP的方法。
[Abstract]:Objective: to explore the clinical effect and significance of comprehensive interventional therapy for tubal pregnancy. Methods: 104 cases of tubal pregnancy treated in Tianyou Hospital of Wuhan University of Science and Technology and Hubei Provincial Maternal and Child Health Hospital from December 2009 to December 2013 were retrospectively analyzed. 52 patients received intramuscular drug injection as control group. The mean age, menopause time, blood 尾-HCG value and pelvic mass diameter were compared between the two groups, and the morphologic features of arteriography were observed. The cure rate, serum 尾-HCG value, the time of pelvic mass absorption, the time of menorrhagia returning to normal, and the incidence of adverse reactions were compared between the two groups after treatment. The changes of E2LHH FSH were observed before operation, 3 months after operation and 6 months after operation, and the oviduct patency of the two groups was observed by HSG, on the third day after menstruation returned to normal and clean. The results were analyzed statistically. Results: 1. There was no significant difference in mean age, menopause time, blood 尾-HCG value and pelvic mass diameter between the two groups (P0.05). 2. Uterine arteriography in the study group can be divided into two types according to its morphology: type 1, no obvious signs, type 2 substantial phase of small chorionic villi staining. 3. In the study group, the cure rate was 96.15, the 尾-HCG value of blood decreased to normal 17.60 鹵6.29 days, the absorption time of pelvic mass was 26.98 鹵6.23 days, the time of menstruation returning to normal was 32.64 鹵4.88 days, and the incidence of adverse reaction was 6.00; In the control group, the cure rate was 76.92, the 尾-HCG value of blood decreased to normal 22.75 鹵7.91 days, the absorption time of pelvic mass was 30.30 鹵8.23 days, the time of menstruation returning to normal was 34.58 鹵5.82 days, and the incidence of adverse reaction was 27.50. By statistical analysis, the cure rate (P0.01), blood 尾-HCG value decreased to normal time (P0.01), pelvic mass absorption time (P0.05), incidence of adverse reactions (P0.01) were significantly different between the two groups. There was no significant difference in menstrual recovery time between the two groups (P0.05). 4. There was no significant difference between the study group and the study group before operation, 3 months after operation and 6 months after operation (P 0.05). 5. The rate of tubal patency was 92.50% in the study group and 76.32% in the control group (P0.05). Conclusion: 1. In the treatment of TP, the comprehensive interventional therapy is better than the single dose drug treatment, the recovery is faster, the adverse reaction is less, the superiority is obvious. 2. Uterine arteriography has high value in diagnosis and treatment of TP. It can complement the advantages of B-ultrasound examination and determination of blood 尾-HCG, and has important significance for accurate diagnosis, localization and prediction of therapeutic effect. 3. Comprehensive interventional therapy can effectively prevent and reduce the bleeding of TP rupture and keep the tubal intact to the maximum extent. 4. Comprehensive interventional therapy (TP) had no significant effect on ovarian function. 5. Comprehensive interventional therapy is a minimally invasive, accurate, safe and effective method for the treatment of TP.
【學(xué)位授予單位】：武漢科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.221

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