發(fā)布時間：2019-08-14 08:43

【摘要】：目的:探討子宮動脈化療栓塞術(shù)治療胎盤植入的臨床療效及預(yù)后。方法:以胎盤植入患者61例為研究對象,按治療方式不同分為保守治療組31例和化療栓塞組30例。保守治療組僅單純口服米非司酮治療,而化療栓塞組采用子宮動脈化療栓塞術(shù)進(jìn)行治療。比較兩組患者的臨床療效、手術(shù)時間、出血量、輸血量、住院時間、胎盤排出和月經(jīng)復(fù)潮時間,術(shù)后并發(fā)癥的發(fā)生情況,并隨訪術(shù)后1年患者的月經(jīng)情況和妊娠情況。結(jié)果:經(jīng)子宮動脈化療栓塞術(shù)后29例成功止血,有1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。而保守治療組的31例患者中,因治療失敗導(dǎo)致切除子宮的7例,僅24例有效保留子宮,成功率僅77.4%,嚴(yán)重影響患者以后的生育能力。6例發(fā)生宮腔感染,4例發(fā)生宮腔粘連。子宮動脈化療栓塞組β-HCG恢復(fù)正常時間、輸血量、胎盤完全清除時間、月經(jīng)異常的發(fā)生情況均優(yōu)于保守治療組,差異有統(tǒng)計學(xué)意義(P0.05)。對子宮動脈化療栓塞術(shù)組患者進(jìn)行為期1年的隨訪,14例患者在術(shù)后1個月后有胎盤組織自陰道排出,有11例患者2個月后發(fā)現(xiàn)胎盤殘留,予以清宮術(shù),除3例失訪病例,其余患者在隨訪時間內(nèi)恢復(fù)正常月經(jīng),并有2例再次妊娠者。結(jié)論:采用子宮動脈化療栓塞術(shù)治療胎盤植入,其術(shù)前準(zhǔn)備時間和手術(shù)時間均短,出血控制迅速且并發(fā)癥少,有助于保留患者的子宮,提高患者的生活質(zhì)量。
[Abstract]:Objective: to investigate the clinical effect and prognosis of uterine artery chemoembolization in the treatment of placental implantation. Methods: 61 patients with placental implantation were divided into conservative treatment group (n = 31) and chemoembolism group (n = 30). The conservative treatment group was treated with mifepristone alone, while the chemoembolism group was treated with uterine artery chemoembolism. The clinical efficacy, operation time, bleeding volume, blood transfusion volume, hospitalization time, placental excretion and menstruation time, postoperative complications were compared between the two groups, and the menstruation and pregnancy were followed up one year after operation. Results: 29 cases were successfully hemostatic and 1 case failed to stop bleeding after transuterine artery chemoembolization. There were no serious complications, such as local ischemic necrosis, nerve injury, fever and lower abdominal pain. In the conservative treatment group, 7 cases were resected because of the failure of treatment, only 24 cases effectively preserved the uterus, the success rate was only 77.4%, which seriously affected the fertility of the patients in the future. 6 cases had uterine cavity infection and 4 cases had uterine cavity adhesion. The recovery time of 尾-HCG, the amount of blood transfusion, the time of complete placental clearance and the occurrence of abnormal menstruation in uterine artery chemoembolism group were better than those in conservative treatment group, the difference was statistically significant (P 0.05). The patients in the uterine artery chemoembolism group were followed up for one year. 14 patients had placental tissue excreted from vagina one month after operation, and 11 patients found placental residue 2 months later. Except 3 patients lost follow-up, the other patients returned to normal menstruation within the follow-up time, and 2 patients were pregnant again. Conclusion: the preoperative preparation time and operation time are short, the bleeding control is rapid and the complications are few, which is helpful to preserve the uterus and improve the quality of life of the patients with placental implantation.
【作者單位】： 南京醫(yī)科大學(xué)附屬南京婦幼保健院;
【分類號】：R714.462

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