垂体后叶素及缩宫素宫颈注射联合吸宫术+宫腔镜检查术在Ⅰ~Ⅱ型瘢痕妊娠中的应用

2020-08-31 11:39:23 中国当代医药 2020年21期

[摘要]目的 探討垂体后叶素及缩宫素宫颈注射联合吸宫术+宫腔镜检查术在Ⅰ~Ⅱ型瘢痕妊娠中的应用效果。方法 选取2018年8月~2019年12月我院收治的98例Ⅰ~Ⅱ型瘢痕妊娠患者作为研究对象,依据随机数字表法将患者分为观察组与对照组,每组各49例。对照组患者给予硬膜外麻醉下经阴道瘢痕妊娠病灶清除术,研究组患者给予垂体后叶素及缩宫素宫颈注射联合吸宫术+宫腔镜检查术。比较两组患者的术中出血量、手术时间、血人绒毛膜促性腺激素(HCG)转阴时间、住院时间、住院费用和并发症发生情况。结果 观察组患者的术中出血量少于对照组,手术时间、血HCG转阴时间短于对照组,差异有统计学意义(P<0.05)。观察组患者的住院时间短于对照组,住院费用少于对照组,差异有统计学意义(P<0.05)。观察组患者的并发症总发生率为4.08%,低于对照组的16.33%,差异有统计学意义(P<0.05)。结论 垂体后叶素及缩宫素宫颈注射联合吸宫术+宫腔镜检查术治疗Ⅰ~Ⅱ型瘢痕妊娠的效果显著,能够缩短患者的治疗时间,减少出血,且无手术切口,并发症少,值得临床推广应用。

[关键词]垂体后叶素;缩宫素;宫颈注射;吸宫术;宫腔镜检查术;Ⅰ~Ⅱ型瘢痕妊娠

[中图分类号] R714.461          [文献标识码] A          [文章编号] 1674-4721(2020)7(c)-0106-03

Application of cervical injection of Pituitrin and Oxytocin combined with uterine aspiration + hysteroscopy in type Ⅰ-Ⅱ scar pregnancy

DENG Shu-lan

Department of Gynecology and Obstetrics, Jiangxi Ji′an Maternal and Child Health Hospital, Jiangxi Province, Ji′an   343000, China

[Abstract] Objective To explore the application effect of cervical injection of Pituitrin and Oxytocin combined with uterine aspiration + hysteroscopy in type Ⅰ-Ⅱ scar pregnancy. Methods A total of 98 patients with type Ⅰ-Ⅱ scar pregnancy who were admitted to our hospital from August 2018 to December 2019 were selected as research subjects. According to the random number table method, the patients were divided into observation group and control group, with 49 cases in each group. The control group was given removal of transvaginal scar pregnancy lesions under epidural anesthesia, and the study group was given cervical injection of Pituitrin and Oxytocin combined with uterine aspiration + hysteroscopy. The intraoperative blood loss, surgery time, negative conversion time of blood human chorionic gonadotropin (HCG), length of hospital stay, hospitalization cost and complications were compared between the two groups. Results The intraoperative blood loss in the observation group was less than that in the control group, the surgery time and the negative conversion time of blood HCG were shorter than those in the control group, the differences were statistically significant (P<0.05). The length of hospital stay in the observation group was shorter than that in the control group, and the hospitalization cost was less than that in the control group, the differences were statistically significant (P<0.05). The total incidence rate of complications in the observation group was 4.08%, which was lower than 16.33% in the control group, and the difference was statistically significant (P<0.05). Conclusion Cervical injection of Pituitrin and Oxytocin combined with uterine aspiration + hysteroscopy in the treatment of type Ⅰ-Ⅱ scar pregnancy has a significant effect, which can shorten the treatment time and reduce bleeding, and there is no surgical incision and fewer complications, which is worthy of clinical promotion and application.

吸宫术是用吸管深入宫腔,以负压将胚胎组织吸出而终止妊娠的手术,其适用于妊娠在10周以内自愿要求终止妊娠而无禁忌证者,也可用于Ⅰ~Ⅱ型瘢痕妊娠。对于因Ⅰ~Ⅱ型瘢痕妊娠而終止妊娠者,直接行吸宫术常导致严重的难以控制的子宫出血,因此不可轻易进行吸宫术。本研究在进行吸宫术前先用3 U垂体后叶素+缩宫素10 U于宫颈12点注射,待宫颈外观发白后在进行吸宫术,即可避免子宫大出血。垂体后叶素是从动物脑腺垂体中提取的水溶性成分,包含缩宫素和血管加压素两种不同的药物,对全身小血管有强烈的收缩作用,将其于宫颈12点处注射可以起到很好的止血效果[16-17]。宫腔镜是一种内镜,目前已成为临床诊断和治疗的一个重要的辅助手段,被广泛地应用于宫腔内病变的诊断和治疗,将其应用于瘢痕妊娠的治疗中可以提高疗效[18]。

本研究结果显示,观察组患者的术中出血量少于对照组,手术时间、血HCG转阴时间短于对照组,差异有统计学意义(P<0.05),提示垂体后叶素及缩宫素宫颈注射联合吸宫术+宫腔镜检查术治疗Ⅰ~Ⅱ型瘢痕妊娠能够减少出血量,缩短手术时间及血HCG转阴时间。观察组患者的住院时间短于对照组,住院费用少于对照组,差异有统计学意义(P<0.05),提示体后叶素及缩宫素宫颈注射联合吸宫术+宫腔镜检查术治疗Ⅰ~Ⅱ型瘢痕妊娠能够缩短治疗时间,减少费用。观察组患者的并发症总发生率为4.08%,低于对照组的16.33%,差异有统计学意义(P<0.05),提示体后叶素及缩宫素宫颈注射联合吸宫术+宫腔镜检查术治疗Ⅰ~Ⅱ型瘢痕妊娠并未增加并发症。

综上所述,垂体后叶素及缩宫素宫颈注射联合吸宫术+宫腔镜检查术治疗Ⅰ~Ⅱ型瘢痕妊娠的效果显著,能够缩短治疗时间,减少出血,且无手术切口,并发症少,值得临床推广应用。

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(收稿日期:2020-03-04)

[基金项目]江西省吉安市科学技术局指导性科技计划项目(吉市科计字[2019]8号第86项)

[作者简介]邓淑兰(1981-),女,江西吉安人,本科,主治医师,研究方向:瘢痕妊娠的临床诊断与治疗