宮腔鏡術后妊娠的診斷和處理

發布時間：2013/5/30 10:05:17

宮腔鏡術后妊娠的診斷：宮(gong)(gong)(gong)腔(qiang)鏡(jing)(jing)術(shu)(shu)(shu)(shu)后(hou)(hou)(hou)(hou)(hou)月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)改(gai)善，可(ke)有(you)(you)(you)(you)無(wu)月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)、點滴出血、月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)過(guo)(guo)少(shao)，正常月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)，還有(you)(you)(you)(you)月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)稀(xi)發，可(ke)由有(you)(you)(you)(you)月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)過(guo)(guo)渡(du)(du)到(dao)無(wu)月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)，也可(ke)由無(wu)月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)過(guo)(guo)渡(du)(du)到(dao)有(you)(you)(you)(you)月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)等不同形式(shi)，在過(guo)(guo)渡(du)(du)時還常有(you)(you)(you)(you)淋漓出血的情(qing)況。北京復興醫院統(tong)計該宮(gong)(gong)(gong)腔(qiang)鏡(jing)(jing)術(shu)(shu)(shu)(shu)后(hou)(hou)(hou)(hou)(hou)至妊(ren)(ren)娠(shen)(shen)(shen)(shen)前月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)情(qing)況為：宮(gong)(gong)(gong)頸妊(ren)(ren)娠(shen)(shen)(shen)(shen)1例(li)，輸卵(luan)管妊(ren)(ren)娠(shen)(shen)(shen)(shen)2例(li)及右宮(gong)(gong)(gong)角妊(ren)(ren)娠(shen)(shen)(shen)(shen)1例(li)術(shu)(shu)(shu)(shu)后(hou)(hou)(hou)(hou)(hou)均為月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)過(guo)(guo)少(shao)。26人(ren)(ren)(ren)(ren)32次(ci)(ci)宮(gong)(gong)(gong)內(nei)孕(yun)中，妊(ren)(ren)娠(shen)(shen)(shen)(shen)3次(ci)(ci)的2人(ren)(ren)(ren)(ren)術(shu)(shu)(shu)(shu)后(hou)(hou)(hou)(hou)(hou)月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)過(guo)(guo)少(shao)。妊(ren)(ren)娠(shen)(shen)(shen)(shen)2次(ci)(ci)的2人(ren)(ren)(ren)(ren)中，1人(ren)(ren)(ren)(ren)術(shu)(shu)(shu)(shu)后(hou)(hou)(hou)(hou)(hou)月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)過(guo)(guo)少(shao)。1人(ren)(ren)(ren)(ren)第一(yi)次(ci)(ci)人(ren)(ren)(ren)(ren)流后(hou)(hou)(hou)(hou)(hou)半年無(wu)月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)，再次(ci)(ci)妊(ren)(ren)娠(shen)(shen)(shen)(shen)。妊(ren)(ren)娠(shen)(shen)(shen)(shen)1次(ci)(ci)的24人(ren)(ren)(ren)(ren)中，14例(li)術(shu)(shu)(shu)(shu)后(hou)(hou)(hou)(hou)(hou)月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)過(guo)(guo)少(shao)。6例(li)術(shu)(shu)(shu)(shu)后(hou)(hou)(hou)(hou)(hou)3-6個月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)無(wu)月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)，優化有(you)(you)(you)(you)少(shao)量月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)，3人(ren)(ren)(ren)(ren)術(shu)(shu)(shu)(shu)后(hou)(hou)(hou)(hou)(hou)7個月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)-2年無(wu)月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)，優化月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)不規律或(huo)有(you)(you)(you)(you)少(shao)量月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)。1例(li)術(shu)(shu)(shu)(shu)后(hou)(hou)(hou)(hou)(hou)3個月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)無(wu)月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)即妊(ren)(ren)娠(shen)(shen)(shen)(shen)，這(zhe)些(xie)月(yue)(yue)(yue)(yue)(yue)(yue)(yue)(yue)經(jing)(jing)(jing)(jing)(jing)(jing)(jing)(jing)的變(bian)化導致早(zao)孕(yun)期間很難及時確定妊(ren)(ren)娠(shen)(shen)(shen)(shen)診(zhen)斷，因此，宮(gong)(gong)(gong)腔(qiang)鏡(jing)(jing)術(shu)(shu)(shu)(shu)后(hou)(hou)(hou)(hou)(hou)妊(ren)(ren)娠(shen)(shen)(shen)(shen)的早(zao)期早(zao)期診(zhen)斷有(you)(you)(you)(you)賴(lai)于醫患雙(shuang)方(fang)對妊(ren)(ren)娠(shen)(shen)(shen)(shen)的警惕性和定期隨(sui)訪。

宮腔鏡術后妊娠的處理：一般接(jie)(jie)受(shou)宮(gong)腔鏡術者(zhe)(zhe)均(jun)不(bu)再有(you)生育要(yao)求，故妊娠后多(duo)以(yi)人(ren)工流(liu)產告終(zhong)，接(jie)(jie)診的(de)(de)醫院及術者(zhe)(zhe)應(ying)有(you)各種應(ying)對(dui)困難(nan)人(ren)工流(liu)產的(de)(de)條件。術前(qian)B超檢查，準確(que)判斷胎囊的(de)(de)位(wei)(wei)置，仔細觀(guan)察(cha)宮(gong)腔線(xian)，以(yi)估計手術的(de)(de)難(nan)易(yi)度。對(dui)宮(gong)腔線(xian)欠清(qing)晰或(huo)胎囊位(wei)(wei)置偏(pian)移宮(gong)腔者(zhe)(zhe)最(zui)好術前(qian)宮(gong)頸插管(guan)，術中施(shi)以(yi)麻醉(zui)。在B超監護下(xia)(xia)吸(xi)宮(gong)，探針或(huo)吸(xi)管(guan)置入不(bu)暢或(huo)遇阻時(shi)，可(ke)用(yong)宮(gong)腔鏡檢查宮(gong)頸管(guan)及宮(gong)腔情況(kuang)。如有(you)狹(xia)窄、粘(zhan)連(lian)或(huo)扭曲，可(ke)在B超引導(dao)下(xia)(xia)切開，是(shi)(shi)宮(gong)腔貫通。術終(zhong)不(bu)能確(que)定胚(pei)物是(shi)(shi)否已(yi)完全(quan)吸(xi)凈時(shi)，可(ke)用(yong)宮(gong)腔鏡檢視。本文例2人(ren)工流(liu)產術終(zhong)出(chu)血(xue)迅猛，采用(yong)球囊壓(ya)迫后出(chu)血(xue)停止，為(wei)避(bi)免切除子宮(gong)，球囊壓(ya)迫是(shi)(shi)采取關注(zhu)下(xia)(xia)治療(liao)措施(shi)前(qian)可(ke)供選擇的(de)(de)有(you)效療(liao)法。

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