不同方法治療子宮切口瘢痕妊娠的臨床效果分析
[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
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