摘要
胚物残留(RPOC)是指终止妊娠后部分胎盘或胚胎组织仍残留在宫腔内的情况。可发生在药物流产、人工流产、自然流产后,也可发生在阴道分娩或剖宫产后。RPOC主要临床表现为异常子宫出血、腹痛及月经异常,并可导致感染、宫腔粘连(IUA)、和继发不孕等并发症。治疗RPOC目的是止血、预防和控制感染,避免长期并发症。RPOC的治疗方案主要包括保守治疗和手术治疗。保守治疗涵盖药物治疗以及期待疗法,通过药物促进残留组织排出或等待其自然排出。手术治疗则主要包括宫腔镜手术和清宫术,直接清除子宫内的残留组织,适用于药物治疗效果不佳或残留物较大等情况。在临床治疗中,必须充分考虑患者的个体差异,实施精准的个性化治疗方案。治疗周期过长,不仅显著增加患者的心理与经济压力,还可能诱发其产生恐惧、焦虑、烦躁等负面情绪,进而严重影响其身心健康。本文对胚物残留的发病机制、诊断、鉴别诊断及治疗方法进展进行综述,以期加深对本病的认识,选择合适的治疗方法。
Retained products of conception(RPOC)refer to the condition where placental or embryonic tissues remain in the uterine cavity following a pregnancy termination,and which common occurs in the conditions,such as medical abortion,surgical abortion,spontaneous abortion,vaginal delivery,and cesarean section.The primary clinical manifestations of RPOC include the abnormal uterine bleeding,the abdominal pain and the menstrual irregularities,and which may lead to the infection,the intrauterine adhesions(IUA)and the subsequent infertility.The treatment of RPOC aims to stop bleeding,prevent and control infection and avoid long-term complications.The treatment options for RPOC primarily include the conservative treatment and surgical intervention.The conservative treatments include the medical therapy as well as the expectant management,in which,the residual tissue is expelled by medications or the residual tissue is waited for the natural expelling.The surgical treatment mainly consists of the hysteroscopy surgery and the dilation and curettage(D&C),both of which can directly remove the retained tissue from the uterus and are suitable for the cases where the pharmacological treatment for the patients is ineffective or when the retained tissue is large.In clinical treatment,it is essential to fully consider the individual differences of the patients,and the personalized treatment plans should be precise implemented.If the treatment period is prolonged,it will not only significantly increase the psychological and economic burden of the patient,but also potentially may induce the negative emotions,such as fear,anxiety and irritability,which in turn can severely affect the physical and mental health of the patients.This review summarizes the advances in pathogenesis,diagnosis,differential diagnosis and treatment of RPOC,in order to deepen the understanding of RPOC and to select the optimal treatment strategy for the patients with RPOC.
作者
韩华玉
刘薇
HAN Huayu;LIU Wei(Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan,Shandong Province,250021)
出处
《中国计划生育学杂志》
2025年第6期1455-1460,共6页
Chinese Journal of Family Planning
基金
山东省重点研究发展计划(2019GSF108183)
山东省异位妊娠教学案例库建设(sdyal2023130)。
关键词
胚物残留
发病机制
诊断
治疗
Retained products of conception
Pathogenesis
Diagnosis
Treatment
