【摘要】：研究背景：藥物流產(chǎn)是指使用藥物為主終止早期妊娠的計劃外妊娠補(bǔ)救措施,此法痛苦小、安全、簡便、不良反應(yīng)少,并可避免負(fù)壓吸宮流產(chǎn)術(shù)帶來的風(fēng)險。米非司酮配伍米索前列醇用于藥物流產(chǎn),已在臨床普遍應(yīng)用,完全流產(chǎn)率可達(dá)90%-95%。但是,仍有5%-10%的患者因藥物流產(chǎn)不全而出現(xiàn)不規(guī)則陰道流血,以往對這部分患者大多行清宮術(shù),這不但加重患者的經(jīng)濟(jì)負(fù)擔(dān),而且會增加流產(chǎn)后不孕、月經(jīng)失調(diào)、感染、宮腔粘連等一系列并發(fā)癥的風(fēng)險,對于部分患者存在過度治療的問題；況且,清宮術(shù)應(yīng)用的指征目前也缺乏可靠地循證醫(yī)學(xué)依據(jù)。因此,對藥物流產(chǎn)后不規(guī)則陰道流血的處理是長期以來困擾計劃生育工作者的棘手問題,也是限制藥物流產(chǎn)臨床廣泛應(yīng)用的關(guān)鍵因素,亟待解決。 研究目的：探討藥物流產(chǎn)后陰道流血的臨床處理方式。 研究方法：收集自2010年4月至2011年12月期間因藥物流產(chǎn)絨毛排出2周后仍有陰道出血來我院計劃生育門診就診的患者62例,給予婦科檢查、婦科超聲檢查、血β-hCG檢測、宮內(nèi)清出組織常規(guī)病理檢查。 結(jié)果：①超聲檢查結(jié)果：59/62例患者超聲檢查宮內(nèi)探及不均質(zhì)光團(tuán),最小徑線為0.65cm,最大徑線為4.05cm,平均值1.44±0.79cm；3/62例患者超聲檢查宮內(nèi)未探及不均質(zhì)光團(tuán)。②血β-hCG檢測結(jié)果：58/62例患者血β-hCG檢測高于正常值,最低值27.48mIU/L最高值為3577.11mIU/L,均值699.74.±125.06mIU/L,4/62例患者血β-hCG檢測結(jié)果正常。③病理檢查結(jié)果：50/62例患者查見胎盤絨毛占80.65%；9/62例患者查見蛻膜組織,占14.51%；2/62例患者為增生期子宮內(nèi)膜伴息肉樣改變,占3.23%；1/62例患者為增生期子宮內(nèi)膜,占1.61%。 結(jié)論：①本研究發(fā)現(xiàn)：藥物流產(chǎn)后陰道流血的患者95.16%是由于絨毛或蛻膜組織殘留引起。②藥物流產(chǎn)絨毛排出后陰道流血超過14天(平均28天)、超聲檢查宮腔內(nèi)探及不均質(zhì)光團(tuán)或血β-hCG水平高于正常均可以考慮清宮。
[Abstract]:Background: drug abortion is an unplanned pregnancy remedy that uses drugs to terminate early pregnancy. It has the advantages of less pain, safety, simplicity, less adverse reactions, and can avoid the risk of negative pressure uterine abortion. Mifepristone combined with misoprostol has been widely used in clinical practice. The complete abortion rate can reach 90-95. However, there are still 5- 10% of the patients who have irregular vaginal bleeding due to incomplete medical abortion. In the past, most of these patients were treated with uterine cleaning, which not only increased the economic burden of the patients, but also increased infertility after abortion and menstrual disorders. Infection, intrauterine adhesions and other complications of a series of risks, for some patients with over-treatment problems; Moreover, the indication of the application of Qing Gong surgery is also lack of reliable evidence-based medicine basis at present. Therefore, the treatment of irregular vaginal bleeding after drug abortion is a thorny problem for family planning workers for a long time, and also a key factor to limit the wide application of drug abortion. Objective: to explore the clinical management of vaginal bleeding after drug abortion. Methods: from April 2010 to December 2011, 62 patients who still had vaginal bleeding in our family planning clinic from April 2010 to December 2011 were given gynecological examination, gynecological ultrasound examination and blood 尾-hCG test. Routine pathological examination of intrauterine clear tissue. Results: (1) Ultrasonography: in 59 / 62 patients, intrauterine uneven light masses were examined by ultrasound, the minimum diameter was 0.65 cm, the maximum diameter was 4.05 cm, the average value was 1.44 鹵0.79 cm; 3 / 62 patients were examined by ultrasound. 2 results of blood 尾-hCG: the detection of 尾-hCG in 58 / 62 patients was higher than the normal value, the lowest 27.48mIU/L was 3 577.11mIUL, the highest value was 3577.11mIUL, the highest value was 3577.11mIUL. The mean value was 699.74. 鹵125.06mIUL / L / 4 / 62 patients' blood 尾-hCG was normal. 3 pathological results: 50 / 62 patients found that placental villi accounted for 80.65%; Decidual tissue was found in 9 / 62 cases, accounting for 14.51% and 62 cases with proliferative endometrium with polyp like changes, 3.23 / 62 cases with proliferative endometrium and 1.61g / 62 cases with proliferative endometrium. Conclusion: 1 in this study, we found that 95.16% of the patients with vaginal bleeding after drug abortion were caused by residual villi or decidua. Ultrasound examination of intrauterine uneven light masses or blood 尾-hCG levels higher than the normal can be considered to clear the uterus.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R169.42

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