【作者】 李静静；

【导师】 史惠蓉；

【作者基本信息】 郑州大学 ， 妇产科学（专业学位）， 2020， 硕士

【摘要】 目的:探究腹腔镜下子宫动脉阻断联合病灶切除术治疗剖宫产瘢痕妊娠的临床价值。方法:回顾性分析2017年8月-2019年8月我院(鹤壁市人民医院)接受治疗的Ⅱ型剖宫产瘢痕妊娠患者80例,患者的年龄范围为23至49岁,平均年龄为32.98±4.56岁,其中双侧子宫动脉栓塞术联合清宫术为A组38例,腹腔镜下子宫动脉阻断联合病灶切除术为B组42例。分析医疗记录包括年龄,胎龄,剖宫产的次数,上次妊娠与剖宫产瘢痕妊娠之间的时间间隔以及临床治疗方案等各项指标和预后情况。结果:本研究结果显示,B组的手术时间明显短于A的手术时间(P<0.05)。A与B组相比,术中失血量明显增加,且差异具有统计学意义(P<0.05)。A组的成功率为97.37%,B组的成功率为95%,比较两组患者的手术成功率结果显示差异无统计学意义(P>0.05)。但是B组的术后阴道出血持续时间、血清β-HCG恢复正常时间和月经恢复时间均较A组的显著缩短,都存在显著的统计学差异(P<0.05)。患者在进行手术治疗后出现的并发症主要包括有术后发烧,栓塞后综合症,术后疼痛,术中邻近器官损伤,术后大出血和宫颈管粘连等,两组患者术后并发症的发生率均无明显差异(P>0.05)。B组的住院时间明显短于A组的住院时间(P<0.05),总住院费用也明显低于A组,差异具有统计学意义(P<0.05)。结论:腹腔镜下子宫动脉阻断联合清宫术手术时间短,术中出血量少,恢复快,住院时间短,费用低,保留生育功能,术后阴道出血持续时间、血清β-HCG恢复正常时间和月经恢复时间短。研究结果表明腹腔镜下子宫动脉阻断联合病灶切除术治疗剖宫产瘢痕妊娠有较好的治疗效果和临床应用价值,为腹腔镜下子宫动脉阻断联合病灶切除术的应用进行总结和拓展,也进一步优化剖宫产瘢痕妊娠的治疗方案,提高患者的生活质量,较少患者的痛苦和经济压力。更多还原

【Abstract】 Objective:To explore the clinical value of laparoscopic uterine artery block combined with focal resection for cesarean scar pregnancy therapy.Methods:Retrospective analysis of 80 cases of cesarean scar pregnancy patients treated in our hospital from August 2017 to August 2019.The age range of the patients was 23 to 49 years,and the average age was 32.98 ± 4.56 years,including bilateral uterus Arterial embolization combined with hysterectomy was performed in 38 patients in group A,and laparoscopic uterine artery block combined with focal resection was performed in 42 patients in group B.Analysis of medical records include age,gestational age,number of previous cesarean sections,the time interval between the last pregnancy and cesarean scar pregnancy,and clinical indicators and prognosis.Results:The results of this study show that the operation time of laparoscopic descending branch of uterine artery combined with uterine surgery is significantly shorter than that of bilateral uterine artery embolization combined with uterine surgery(P<0.05).Compared with laparoscopic uterine artery occlusion and hysterectomy under bilateral uterine artery embolization combined with hysterectomy,the intraoperative blood loss was significantly increased,and the difference was statistically significant(P<0.05).The success rate of bilateral uterine arterial embolization combined with hysterectomy was 97.37%,and the success rate of laparoscopic descending branch uterine artery block combined with hysterectomy was 95%.Comparing the surgical success rates of the two groups,the results showed no significant difference.(P>0.05).However,the duration of vaginal bleeding,the time of serum β-HCG return to normal,and the period of menstrual recovery were significantly shorter than those of bilateral uterine arterial embolization combined with hysterectomy,and there were significant statistics.The difference was significant(P<0.05).Complications that occurred after surgical treatment included postoperative fever,post-embolism syndrome,postoperative pain,adjacent organ damage during surgery,postoperative bleeding,and cervical canal adhesions.Postoperative complications occurred in the two groups of patients.The rates were not significantly different(P>0.05).The length of hospital stay of patients undergoing laparoscopic uterine artery occlusion and hysterectomy was significantly shorter than that of patients in group A with bilateral uterine arterial embolization combined with hysterectomy(P<0.05).In the group,bilateral uterine arterial embolization combined with hysterectomy was statistically significant(P<0.05)Conclusion:Laparoscopic uterine artery descending branch block combined with hysterectomy has a short operation time,low intraoperative blood loss,fast recovery,short hospital stay,low cost,fertility preservation,postoperative vaginal bleeding duration,and serum β-HCG return to normal time And menstrual recovery time is short.Postoperative complications were fewer.The results show that laparoscopic uterine artery occlusion combined with focal resection has better therapeutic effect and clinical value for cesarean scar pregnancy.It summarizes and expands the application of laparoscopic uterine artery occlusion combined with focal resection.It also further optimizes the treatment plan for cesarean scar pregnancy,improves the prognosis of patients,and reduces the pain and economic pressure of patients.更多还原