南疆县域内不同的流产方式对早期妊娠稽留流产患者治疗效果分析

Analysis of therapeutic effect of different abortion methods on missed abortion in early pregnancy in southern Xinjiang

目的发现当早期妊娠患者发生稽留流产后,采取不同的流产方式对宫腔粘连、宫内残留发生率的影响,同时在医疗资源有限的情况下选择一种适合本地居民更佳的治疗方案。方法本文分析研究2021年1月至2022年12月在阿克苏地区拜城县人民医院妇科就诊的早期妊娠稽留流产患者,共纳入患者100例。采用随机数表法分为两组,每组50例患者,根据采取的流产方式,将患者分为常规操作组(直接清宫),联合治疗组(先药物,再清宫),分析两组病例的一般资料、流产前孕囊大小,操作时间,术中出血量,术后疼痛评分,术后发现宫内残留,术后发生宫腔粘连数,术后出现盆腔炎等情况进行比较分析。结果两组患者的年龄、民族、妊娠时间、手术前BMI,流产次数,产次、孕囊大小相比较,无统计学差异(P>0.05)。两组手术后均有少数患者出现盆腔炎,相比较差异无统计学意义(P>0.05)。两组患者均有发生宫腔粘连,粘连程度均为轻度粘连,常规操作组患者宫腔粘连的发生率高于联合治疗组,差异具有统计学意义(P<0.05)。常规操作组宫腔残留的发生率也高于联合治疗组,差异具有统计学意义(P<0.05)。常规操作组医护人员在宫腔手术操作时间明显高于联合治疗组,差异具有统计学意义(P<0.05);但两者操作时阴道出血量和手术后阴道持续流血时间均无显著差异(P>0.05)。常规操作组手术后疼痛评分也高于联合治疗组,差异具有统计学意义(P<0.05)。结论在基层医院医疗条件不够充分的情况下,早期妊娠稽留流产患者可以先选择药物做术前预处理防控方案,再选择清宫,具有良好的临床疗效。可以有效降低宫内残留的发生,有效预防宫腔粘连,有利于改善患者术后生活质量,值得在临床工作中推广应用。

Objective To analysis the effects of different abortion methods on the incidence of intrauterine adhesion and intrauterine residual after missed abortion in early pregnancy patients,and to select a better treatment for local residents under the circumstances of limited medical resources.Methods A total of 100 missed abortion patients who received gynecological treatment in our hospital from January 2021 to December 2022 were analyzed and studied.The patients were divided into two groups by double-blind method,with 50 patients in each group.According to the abortion method taken by the patients,the patients were divided into the operation group and the combined treatment group.The general information,the size of pregnancy sac before abortion,operation time,intraoperative blood loss,postoperative pain score,intrauterine residue found after surgery,the number of intrauterine adhesion after surgery,and the occurrence of pelvic inflammatory disease after surgery were analyzed.Results There were no significant differences in age,nationality,gestation time,pre-operation BMI,abortion number,birth time and gestational sac size between the two groups(P>0.05).A small number of patients in both groups developed pelvic inflammatory disease after operation,with no statistical significance(P>0.05).Intrauterine adhesions occurred in both groups,and the degree of adhesions was mild.The incidence of intrauterine adhesions in the operation group was higher than that in the combined treatment group,and the difference was statistically significant(P<0.05).The incidence of uterine residue in the operation group was also higher than that in the combined treatment group(P<0.05).The operation time in the operation group was significantly higher than that in the combined treatment group(P<0.05).However,there were no significant differences in the amount of vaginal bleeding during operation and the duration of vaginal bleeding after operation(P>0.05).The postoperative pain score of the operation group was higher than that of the combined treatment group(P<0.05).Conclusion In case of medical conditions in primary hospitals,patients with missed abortion in early pregnancy can first choose drugs for pre-treatment prevention and control program before choosing artificial abortion,which has good clinical efficacy.It can effectively reduce the occurrence of intrauterine residue,effectively prevent intrauterine adhesions,and is conducive to improving the quality of life of patients after surgery.It is worth promoting and applying in clinical work.