不同方法治療子宮切口瘢痕妊娠的臨床效果分析
發(fā)布時間：2019-02-17 20:47
【摘要】：背景和目的 剖宮產(chǎn)后子宮切口瘢痕妊娠（cesarean scar pregnancy, CSP）是指有剖宮產(chǎn)史的女性再次妊娠時，胚胎著床于前次剖宮產(chǎn)子宮切口部位，是一種罕見的異位妊娠。因其無特殊臨床特征，故容易被誤診或漏診，常常因不恰當(dāng)?shù)那鍖m而導(dǎo)致不可抑制的子宮大出血，嚴(yán)重者可能危及生命。以往因該疾病發(fā)病稀疏，人們對其認(rèn)識不足，多數(shù)大出血患者最終以切除子宮的方式挽救生命，從而喪失了生育能力。近些年來，隨著剖宮產(chǎn)率的不斷增高，CSP的發(fā)病率也呈逐步上升趨勢，人們對該疾病的認(rèn)識也在不斷加深。越來越多的報道分析研究了該病的病因、機制以及治療方法。但CSP的確切病因至今仍尚不明確，雖然隨著超聲技術(shù)的提高和各種治療方法的改進(jìn)，保留生育能力的各項治療措施已經(jīng)基本代替了子宮切除術(shù)，但各地報道的治療經(jīng)驗和結(jié)果各不相同，目前仍缺乏統(tǒng)一有效地的治療方法。為探求CSP的最佳治療方案，本研究回顧性分析了近5年來收治的113例CSP患者的臨床資料，以期能為臨床醫(yī)師在CSP治療的方案選擇上提供初步的臨床依據(jù)。 資料與方法 1.一般資料 收集鄭州大學(xué)第一附屬醫(yī)院及焦作市婦幼保健院2008年5月至2013年5月收治住院的CSP患者113例為研究對象，其中孕囊型44例，團(tuán)塊型67例，中孕型2例。除2例中孕型CSP外，余111例CSP患者分別以不同類型不同治療方式分組進(jìn)行分析對比，其中局部注射甲氨蝶呤（methotrexate，MTX）組35例、全身應(yīng)用MTX組35例，介入組31例，手術(shù)組10例。因治療不滿意而改變治療方式后，有3例最初采用局部應(yīng)用MTX方案的患者更改方案，其中有1例改為介入治療，2例改為手術(shù)治療；有6例最初全身應(yīng)用MTX治療的患者和3例最初介入治療的患者改為手術(shù)治療。 2.研究方法 對研究對象的病例資料進(jìn)行回顧性分析對比，監(jiān)測治療后一周血人絨毛膜促性腺激素（human chorionic gonadotropin，，HCG）變化情況及其轉(zhuǎn)陰時間，觀察治療期間陰道出血情況及不良反應(yīng)、治療后包塊超聲影像變化，分析住院天數(shù)、住院費用及治愈率。 3.統(tǒng)計學(xué)分析 用SPSS13.0統(tǒng)計軟件對數(shù)據(jù)進(jìn)行分析，計量資料以x±s表示，率的比較采用χ2檢驗，P0.05為差異有統(tǒng)計學(xué)意義。 結(jié)果 1.手術(shù)治療血HCG下降最快，住院時間、包塊消失時間及HCG轉(zhuǎn)陰時間最短，介入栓塞治療次之，均與MTX全身治療相比差異明顯（P0.05） 2.局部應(yīng)用MTX對孕囊型的療效明顯優(yōu)于團(tuán)塊型（P0.05） 3.介入栓塞治療費用最高（P0.05） 結(jié)論 1.CSP的治療應(yīng)實行個體化治療 2.孕囊穿刺局部MTX注藥可作為孕囊型患者治療的首選方法 3.介入栓塞治療可作為團(tuán)塊型患者的治療首選 4.對于保守治療無效者可改為手術(shù)子宮病灶切除+修復(fù)術(shù) 5.對于病灶較大，子宮局部肌層菲薄，病灶明顯突向膀胱者，應(yīng)考慮直接手術(shù)治療
[Abstract]:Background and objective (cesarean scar pregnancy, CSP) is a rare ectopic pregnancy when a woman with a history of cesarean section is pregnant again, the embryo is implanted in the site of the uterine incision of the previous cesarean section. Because it has no special clinical characteristics, it is easy to be misdiagnosed or missed diagnosis, often due to the improper Qing Palace and lead to irrepressible uterine bleeding, serious may endanger life. In the past, because of the sparse disease, people do not know enough about it. Most patients with massive bleeding eventually save their lives by removing the uterus, thus losing their fertility. In recent years, with the increasing rate of cesarean section, the incidence of CSP is also gradually rising, and people's understanding of the disease is also deepening. More and more reports have analyzed the etiology, mechanism and treatment of the disease. However, the exact cause of CSP is still unclear, although with the improvement of ultrasound technology and various treatments, fertility retention treatment has basically replaced hysterectomy. However, the reported treatment experience and results are different, and there is still a lack of unified and effective treatment methods. In order to explore the best treatment scheme for CSP, the clinical data of 113 patients with CSP admitted in our hospital in recent 5 years were retrospectively analyzed in order to provide a preliminary clinical basis for clinicians to choose the treatment regimen for CSP. Data and methods 1. General data were collected from 113 CSP patients admitted to the first affiliated Hospital of Zhengzhou University and Jiaozuo Maternal and Child Health Hospital from May 2008 to May 2013. 44 cases of gestational sac type, 67 cases of mass type and 2 cases of middle pregnancy type were studied. In addition to 2 cases of pregnancy type CSP, the remaining 111 cases of CSP were divided into three groups: local injection of methotrexate (methotrexate,MTX) group (35 cases), systemic application of MTX group (35 cases), interventional group (31 cases), and operation group (10 cases). After the treatment was changed because of unsatisfactory treatment, there were 3 patients who were treated with local MTX regimen at first, including 1 patient undergoing interventional therapy and 2 patients undergoing surgical treatment. Surgical treatment was performed in 6 patients with initial systemic MTX therapy and 3 patients with initial interventional therapy. 2. Methods the data of the patients were retrospectively analyzed and compared to monitor the changes of serum human chorionic gonadotropin (human chorionic gonadotropin,HCG) and the time of turning negative one week after treatment. The bleeding and adverse reactions of vagina during the treatment period were observed. The changes of ultrasonic images of the mass after treatment were observed, and the days of hospitalization, the cost of hospitalization and the cure rate were analyzed. 3. Statistical analysis using SPSS13.0 statistical software to analyze the data, the measurement data expressed as x 鹵s, the rate of comparison using 蠂 2 test, P0.05 as the difference was statistically significant. Result 1. The decrease of blood HCG was the fastest, the time of hospitalization, the time of mass disappearance and the time of HCG turning negative was the shortest in surgical treatment, the second was interventional embolization, which was significantly different from that of MTX (P0.05). The effect of local application of MTX on gestational sac type was significantly better than that on mass type (P0.05) 3. The cost of interventional embolization is the highest (P0.05) conclusion the treatment of 1.CSP should be individualized 2. Local MTX injection can be used as the first choice for the treatment of gestational sac type patients. Interventional embolization can be used as the first choice for mass type patients. For patients with ineffective conservative treatment, surgical hysterectomy and repair of uterine lesions can be replaced by 5. 5%. Direct surgical treatment should be considered for those with larger lesions, thin local myometrium and obvious focus to bladder.
【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】：2014
【分類號】：R714.2
本文編號：2425573
[Abstract]:Background and objective (cesarean scar pregnancy, CSP) is a rare ectopic pregnancy when a woman with a history of cesarean section is pregnant again, the embryo is implanted in the site of the uterine incision of the previous cesarean section. Because it has no special clinical characteristics, it is easy to be misdiagnosed or missed diagnosis, often due to the improper Qing Palace and lead to irrepressible uterine bleeding, serious may endanger life. In the past, because of the sparse disease, people do not know enough about it. Most patients with massive bleeding eventually save their lives by removing the uterus, thus losing their fertility. In recent years, with the increasing rate of cesarean section, the incidence of CSP is also gradually rising, and people's understanding of the disease is also deepening. More and more reports have analyzed the etiology, mechanism and treatment of the disease. However, the exact cause of CSP is still unclear, although with the improvement of ultrasound technology and various treatments, fertility retention treatment has basically replaced hysterectomy. However, the reported treatment experience and results are different, and there is still a lack of unified and effective treatment methods. In order to explore the best treatment scheme for CSP, the clinical data of 113 patients with CSP admitted in our hospital in recent 5 years were retrospectively analyzed in order to provide a preliminary clinical basis for clinicians to choose the treatment regimen for CSP. Data and methods 1. General data were collected from 113 CSP patients admitted to the first affiliated Hospital of Zhengzhou University and Jiaozuo Maternal and Child Health Hospital from May 2008 to May 2013. 44 cases of gestational sac type, 67 cases of mass type and 2 cases of middle pregnancy type were studied. In addition to 2 cases of pregnancy type CSP, the remaining 111 cases of CSP were divided into three groups: local injection of methotrexate (methotrexate,MTX) group (35 cases), systemic application of MTX group (35 cases), interventional group (31 cases), and operation group (10 cases). After the treatment was changed because of unsatisfactory treatment, there were 3 patients who were treated with local MTX regimen at first, including 1 patient undergoing interventional therapy and 2 patients undergoing surgical treatment. Surgical treatment was performed in 6 patients with initial systemic MTX therapy and 3 patients with initial interventional therapy. 2. Methods the data of the patients were retrospectively analyzed and compared to monitor the changes of serum human chorionic gonadotropin (human chorionic gonadotropin,HCG) and the time of turning negative one week after treatment. The bleeding and adverse reactions of vagina during the treatment period were observed. The changes of ultrasonic images of the mass after treatment were observed, and the days of hospitalization, the cost of hospitalization and the cure rate were analyzed. 3. Statistical analysis using SPSS13.0 statistical software to analyze the data, the measurement data expressed as x 鹵s, the rate of comparison using 蠂 2 test, P0.05 as the difference was statistically significant. Result 1. The decrease of blood HCG was the fastest, the time of hospitalization, the time of mass disappearance and the time of HCG turning negative was the shortest in surgical treatment, the second was interventional embolization, which was significantly different from that of MTX (P0.05). The effect of local application of MTX on gestational sac type was significantly better than that on mass type (P0.05) 3. The cost of interventional embolization is the highest (P0.05) conclusion the treatment of 1.CSP should be individualized 2. Local MTX injection can be used as the first choice for the treatment of gestational sac type patients. Interventional embolization can be used as the first choice for mass type patients. For patients with ineffective conservative treatment, surgical hysterectomy and repair of uterine lesions can be replaced by 5. 5%. Direct surgical treatment should be considered for those with larger lesions, thin local myometrium and obvious focus to bladder.
【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】：2014
【分類號】：R714.2
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 譚海平;;子宮切口瘢痕妊娠30例臨床分析[J];醫(yī)學(xué)臨床研究;2008年08期
2 張曉燕;王紅靜;賈西彪;楊琴;郄明蓉;王雪;;剖宮產(chǎn)術(shù)后子宮瘢痕處妊娠103例臨床分析[J];四川大學(xué)學(xué)報(醫(yī)學(xué)版);2010年04期
3 朱麗英;代翠婷;;異位妊娠誤診21例臨床分析[J];局解手術(shù)學(xué)雜志;2007年02期
4 馬永紅;劉愛敏;錢虹;朱珉;;剖宮產(chǎn)后子宮瘢痕處妊娠34例診斷和治療分析[J];昆明醫(yī)學(xué)院學(xué)報;2010年04期
5 陳淑婷;汪江杰;;彩色多普勒超聲診斷剖宮產(chǎn)瘢痕部位妊娠(附15例報告)[J];現(xiàn)代實用醫(yī)學(xué);2007年06期
6 鄭俊娥;張向麗;;剖宮產(chǎn)率、剖宮產(chǎn)指征變化及其與圍生兒結(jié)局的關(guān)系[J];山東醫(yī)藥;2008年18期
7 周洪友;王小尚;;剖宮產(chǎn)術(shù)后子宮瘢痕處妊娠2例[J];實用婦產(chǎn)科雜志;2009年02期
8 龍麗霞;欒樺;柳肅芬;;剖宮產(chǎn)術(shù)后瘢痕處妊娠15例臨床分析[J];實用婦產(chǎn)科雜志;2009年04期
9 張燕科;吳瑞瑾;林俊;;剖宮產(chǎn)術(shù)后子宮瘢痕處妊娠的早期診斷與治療[J];實用婦產(chǎn)科雜志;2009年12期
10 邱芳華,沈澄潔;剖宮產(chǎn)切口處異位妊娠的臨床分析[J];上海醫(yī)學(xué);2002年04期
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