剖宫产瘢痕妊娠临床分析
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摘要
目的探讨分析不同方法治疗剖宫产瘢痕妊娠的临床效果。方法回顾性分析我院2015年2月～2018年12月共收治的120例剖宫产瘢痕妊娠患者临床资料,根据所采用的不同治疗方法将其分为A、B、C、D四组,每组所采用的治疗方法为超声引导下清宫手术(12例)、子宫动脉栓塞术联合甲氨蝶呤后超声引导下清宫术(85例)、开腹子宫瘢痕妊娠物清除术(14例)、子宫动脉栓塞术联合甲氨蝶呤后腹腔镜监控下清宫术(9例)。比较各组患者治疗前后临床症状与预后特点。结果所有患者均治愈,无子宫切除。所有患者停经天数、年龄、生产次数、妊娠次数、人流次数、剖宫产次数、距离上次剖宫产时间、术后48h黄体酮下降幅度以及住院时间等均无显著差异(P>0.05)。各组术中出血量和手术时间存在显著性差异(P<0.05),住院时间无显著性差异(P>0.05)。结论超声引导下清宫术临床操作简单,对患者造成的损伤小,且费用低。腹腔镜与开腹手术适用于外源性CSP患者,手术风险更低,可有效避免子宫穿孔,但是腹腔镜手术费用较高,并且手术时间长、出血量大、住院时间久。临床治疗中需要根据患者实际情况来制定个性化治疗方案。
Objective To explore and analyze the clinical effects of different methods in the treatment of cesarean scar pregnancy.Methods The clinical data of 120 cases of cesarean scar pregnancy from February 2016 to March 2018 in our hospital were retrospectively analyzed. According to the different treatment methods, they were divided into four groups:A,B,C and D.The treatment methods used in each group were ultrasound-guided uterine clearance(12 cases),uterine artery embolization combined with methotrexate-guided uterine clearance(85 cases),and laparotomy uterus. Scar removal of pregnancy(14 cases),uterine artery embolization combined with methotrexate after laparoscopic monitoring uterine curettage(9 cases).The clinical symptoms and prognosis of each group were compared before and after treatment.Results All patients were cured without hysterectomy.There were no significant differences in the number of days of menopause,age,number of births, number of pregnancies,number of abortions,number of cesarean sections,distance from the last cesarean section,the decrease of progesterone48 hours after operation and length of hospital stay(P>0.05).There were significant differences in intraoperative bleeding volume and operation time between groups(P<0.05),and no significant difference in hospital stay(P>0.05).Conclusion Ultrasound-guided uterine curettage is simple in clinical operation,less damage to patients and low in cost.Laparoscopy and laparotomy are suitable for exogenous CSP patients. They are less risky and can effectively avoid uterine perforation.However,laparoscopic surgery costs more,and has a long operation time,a large amount of bleeding and a long hospital stay.In clinical treatment, individualized treatment plan should be formulated according to the actual situation of patients.
Objective To explore and analyze the clinical effects of different methods in the treatment of cesarean scar pregnancy.Methods The clinical data of 120 cases of cesarean scar pregnancy from February 2016 to March 2018 in our hospital were retrospectively analyzed. According to the different treatment methods, they were divided into four groups:A,B,C and D.The treatment methods used in each group were ultrasound-guided uterine clearance(12 cases),uterine artery embolization combined with methotrexate-guided uterine clearance(85 cases),and laparotomy uterus. Scar removal of pregnancy(14 cases),uterine artery embolization combined with methotrexate after laparoscopic monitoring uterine curettage(9 cases).The clinical symptoms and prognosis of each group were compared before and after treatment.Results All patients were cured without hysterectomy.There were no significant differences in the number of days of menopause,age,number of births, number of pregnancies,number of abortions,number of cesarean sections,distance from the last cesarean section,the decrease of progesterone48 hours after operation and length of hospital stay(P>0.05).There were significant differences in intraoperative bleeding volume and operation time between groups(P<0.05),and no significant difference in hospital stay(P>0.05).Conclusion Ultrasound-guided uterine curettage is simple in clinical operation,less damage to patients and low in cost.Laparoscopy and laparotomy are suitable for exogenous CSP patients. They are less risky and can effectively avoid uterine perforation.However,laparoscopic surgery costs more,and has a long operation time,a large amount of bleeding and a long hospital stay.In clinical treatment, individualized treatment plan should be formulated according to the actual situation of patients.
引文
[1]王小芳,徐桂梅,朱华花,宋圆圆.剖宫产瘢痕妊娠患者围术期中临床护理路径的效果分析[J].首都食品与医药,2018,25(23):78.
[2]赵艳超,温道清.阴式辅助下吸宫治疗剖宫产瘢痕部位妊娠30例临床分析[J].中国实用医药,2018,13(31):71-73.
[3]张小围,杨悦.剖宫产术后瘢痕妊娠153例临床分析[J].中国医刊,2018,53(11):1257-1261.
[4]郭瑞红.剖宫产术后再次妊娠子宫瘢痕破裂的临床分析[J].中国医药指南,2017,15(36):78-79.
[5]冯涛.经阴道彩色多普勒超声诊断剖宫产切口瘢痕妊娠的临床价值分析[J].中国实用医药,2017,12(36):88-90.
[6]马晶.剖宫产术后子宫瘢痕妊娠30例临床分析[J].青海医药杂志,2017,47(12):5-7.
[2]赵艳超,温道清.阴式辅助下吸宫治疗剖宫产瘢痕部位妊娠30例临床分析[J].中国实用医药,2018,13(31):71-73.
[3]张小围,杨悦.剖宫产术后瘢痕妊娠153例临床分析[J].中国医刊,2018,53(11):1257-1261.
[4]郭瑞红.剖宫产术后再次妊娠子宫瘢痕破裂的临床分析[J].中国医药指南,2017,15(36):78-79.
[5]冯涛.经阴道彩色多普勒超声诊断剖宫产切口瘢痕妊娠的临床价值分析[J].中国实用医药,2017,12(36):88-90.
[6]马晶.剖宫产术后子宫瘢痕妊娠30例临床分析[J].青海医药杂志,2017,47(12):5-7.