子宫动脉栓塞术联合宫腔镜下刮宫术与药物联合刮宫术治疗宫颈妊娠临床效果分析
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摘要
目的比较子宫动脉栓塞术联合宫腔镜下刮宫术与传统药物联合刮宫术治疗宫颈妊娠的临床效果。方法选取宫颈妊娠42例作为研究对象,按照入院的时间序号交替分为观察组和对照组两组,每组各21例。观察组采用子宫动脉栓塞术联合宫腔镜下刮宫术治疗,对照组采用传统药物联合刮宫术治疗,观察比较两组临床疗效,术中出血量、阴道流血时间、住院时间及血人绒毛膜促性腺激素(β-HCG)转阴时间,术中输血情况,以及术后并发症发生情况。结果观察组治疗后总有效率为95. 24%高于对照组治疗后总有效率76. 19%,差异有统计学意义(P <0. 05)。观察组术中出血量少于对照组,阴道流血时间、住院时间及血β-HCG转阴时间短于对照组,差异具有统计学意义(P <0. 05)。观察组术中无一例行输血治疗,对照组术中2例因失血过多进行输血治疗。观察组术后发生下腹部疼痛1例,并发症发生率为4. 76%,对照组术后发生下腹部疼痛、发热及宫颈粘连各1例,并发症发生率为14. 29%。结论子宫动脉栓塞术联合宫腔镜下刮宫术较传统药物联合刮宫术治疗宫颈妊娠临床效果显著,可减少出血量,缩短阴道流血时间、住院时间及血β-HCG转阴时间,且术后并发症少。
Objective To compare the clinical effects of uterine artery embolization( UAE) combined with hysteroscopic uterine curettage and traditional medicine combined with curettage on cervical pregnancy( CP). Methods Forty-two patients with CP were selected as the study subjects. They were divided into observation group and control group according to the time series of admission,with 21 cases in each group. The observation group was treated with UAE combined with hysteroscopic uterine curettage,while the control group was treated with traditional medicine combined with curettage. The clinical efficacy,intraoperative blood loss,duration of vaginal bleeding,length of hospitalization,the time of positve-to-negative switch of blood human chorionic gonadotropin( β-HCG),intraoperative blood transfusion,and postoperative complications were observed and compared. Results The total effective rate was 95. 24% in the observation group,which was higher than that( 76. 19%) in the control group,and the difference was statistically significant( P < 0. 05). The intraoperative blood loss in the observation group was less than that in the control group,and duration of vaginal bleeding,length of hospitalization and time of positive-to-negative switch of blood β-HCG were shorter than those in the control group,suggesting significant difference( P <0. 05). There was no intraoperative blood transfusion in the observation group,whereas two patients in the control group underwent transfusion because of excessive blood loss. One case of lower abdominal pain occurred in the observation group,and the complication rate was 4. 76%. In the control group,there was lower abdominal pain( n = 1),fever( n = 1) and cervical adhesion( n = 1),and the complication rate was 14. 29%. Conclusion UAE combined with hysteroscopic uterine curettage is more effective than traditional medicine combined with curettage for CP. It can reduce the amount of bleeding,shorten duration of vaginal bleeding,length of hospitalization and time of positive-tonegative switch of blood β-HCG,and has fewer postoperative complications.
Objective To compare the clinical effects of uterine artery embolization( UAE) combined with hysteroscopic uterine curettage and traditional medicine combined with curettage on cervical pregnancy( CP). Methods Forty-two patients with CP were selected as the study subjects. They were divided into observation group and control group according to the time series of admission,with 21 cases in each group. The observation group was treated with UAE combined with hysteroscopic uterine curettage,while the control group was treated with traditional medicine combined with curettage. The clinical efficacy,intraoperative blood loss,duration of vaginal bleeding,length of hospitalization,the time of positve-to-negative switch of blood human chorionic gonadotropin( β-HCG),intraoperative blood transfusion,and postoperative complications were observed and compared. Results The total effective rate was 95. 24% in the observation group,which was higher than that( 76. 19%) in the control group,and the difference was statistically significant( P < 0. 05). The intraoperative blood loss in the observation group was less than that in the control group,and duration of vaginal bleeding,length of hospitalization and time of positive-to-negative switch of blood β-HCG were shorter than those in the control group,suggesting significant difference( P <0. 05). There was no intraoperative blood transfusion in the observation group,whereas two patients in the control group underwent transfusion because of excessive blood loss. One case of lower abdominal pain occurred in the observation group,and the complication rate was 4. 76%. In the control group,there was lower abdominal pain( n = 1),fever( n = 1) and cervical adhesion( n = 1),and the complication rate was 14. 29%. Conclusion UAE combined with hysteroscopic uterine curettage is more effective than traditional medicine combined with curettage for CP. It can reduce the amount of bleeding,shorten duration of vaginal bleeding,length of hospitalization and time of positive-tonegative switch of blood β-HCG,and has fewer postoperative complications.
引文
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[13]陈丽荣,李鸥,张俊华,等.结晶天花粉联合氨甲喋呤治疗异位妊娠效果观察[J].山东医药,2016,56(41):76-78.
[14]邹云琴,胡晓云,薛彩星,等.氨甲蝶呤联合米非司酮对输卵管妊娠术后持续性异位妊娠的预防作用[J].宁夏医科大学学报,2017,39(6):702-704.
[15]陈茜,陈丽娟,崔雨蒙,等.超声引导下局部注射氨甲蝶呤在输卵管妊娠保守治疗中的研究[J].中国妇幼健康研究,2016,27(3):373-376.
[16]曾凡湘,史道华,邓婕,等.甲氨蝶呤治疗异位妊娠的疗效及其影响因素分析[J].中国临床药理学杂志,2015,31(5):348-350.
[17]董华娟,邱莉,白凤琴,等.宫腔镜辅助冷刀锥切术与传统冷刀锥切术治疗子宫颈上皮内瘤变III期的临床疗效比较[J].实用医院临床杂志,2016,13(4):73-75.
[18]易水晶,肖松舒,薛敏.宫颈妊娠合并子宫动静脉瘘1例报道并文献复习[J].中国医科大学学报,2015,44(10):940-942.
[19]聂东云,陈素文.子宫动脉栓塞联合宫腔镜下刮宫术治疗宫颈妊娠的临床效果观察[J].临床误诊误治,2017,30(11):86-89.
[2]王晓敏.异位妊娠的发病趋势与临床诊治分析[J].世界临床医学,2016,10(21):137-138.
[3]杨磊,蔺莉.宫颈妊娠10例临床分析[J].中华实用诊断与治疗杂志,2015,29(7):678-679.
[4]樊琳,刘风华,翁慧男,等.体外受精-胚胎移植术后宫内妊娠合并宫颈妊娠2例[J].国际生殖健康/计划生育杂志,2016,35(4):273-276.
[5]朱晓琴.宫颈妊娠大出血患者数字成影血管造影引导下经双侧子宫动脉明胶海绵栓塞联合宫腔镜电切术的临床效果[J].中国妇幼保健,2015,30(25):4388-4390.
[6]乐杰.妇产科学[M]. 6版.北京:人民卫生出版社,2005:117-119.
[7]杨海燕,马立荣,张莉.宫颈环扎术治疗宫颈妊娠流产后出血[J].中国优生与遗传杂志,2016,8(6):74.
[8]田恬,谢兰.高危妊娠管理[J].实用医院临床杂志,2016,13(6):16-18.
[9]李卫珍,祝勤奋,王永英,等.米索前列醇不同给药途径对瘢痕子宫妊娠宫颈的影响[J].中国妇幼健康研究,2015,26(6):1310-1312.
[10]冯艳婕,李丽春,李红梅.子宫栓塞后即刻行刮宫术与单纯刮宫治疗宫颈妊娠的出血及康复效果比较[J].检验医学与临床,2017,14(1):84-86.
[11]周淑贞,莫芸素,许卫蓉.宫颈妊娠介入治疗的围手术期护理[J].中国实用护理杂志,2016,32(z1):55.
[12]杨帅,孙昱,李凯,等.子宫动脉栓塞术治疗妇产科出血性疾病的临床实验研究[J].中国妇幼保健,2015,30(11):1773-1774.
[13]陈丽荣,李鸥,张俊华,等.结晶天花粉联合氨甲喋呤治疗异位妊娠效果观察[J].山东医药,2016,56(41):76-78.
[14]邹云琴,胡晓云,薛彩星,等.氨甲蝶呤联合米非司酮对输卵管妊娠术后持续性异位妊娠的预防作用[J].宁夏医科大学学报,2017,39(6):702-704.
[15]陈茜,陈丽娟,崔雨蒙,等.超声引导下局部注射氨甲蝶呤在输卵管妊娠保守治疗中的研究[J].中国妇幼健康研究,2016,27(3):373-376.
[16]曾凡湘,史道华,邓婕,等.甲氨蝶呤治疗异位妊娠的疗效及其影响因素分析[J].中国临床药理学杂志,2015,31(5):348-350.
[17]董华娟,邱莉,白凤琴,等.宫腔镜辅助冷刀锥切术与传统冷刀锥切术治疗子宫颈上皮内瘤变III期的临床疗效比较[J].实用医院临床杂志,2016,13(4):73-75.
[18]易水晶,肖松舒,薛敏.宫颈妊娠合并子宫动静脉瘘1例报道并文献复习[J].中国医科大学学报,2015,44(10):940-942.
[19]聂东云,陈素文.子宫动脉栓塞联合宫腔镜下刮宫术治疗宫颈妊娠的临床效果观察[J].临床误诊误治,2017,30(11):86-89.