中晚期妊娠胎盘植入患者的临床分析  

Clinical analysis of 47 cases of placenta accreta in the second and third trimesters

作　　者：张超[1] 刘欣燕[1] 范光升[1] 杨剑秋[1] 刘俊涛[1] 边旭明[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院妇产科,100730

出　　处：《中华妇产科杂志》2008年第7期506-509,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨中晚期妊娠发生胎盘植入的高危因素、诊断和治疗方法。方法对北京协和医院1997年5月至2007年5月收治的中晚期妊娠发生胎盘植入的47例患者的临床资料进行回顾性分析。结果（1）发生率：北京协和医院1997年5月至2007年5月的10年间，胎盘植入的总发生率为0．262％（47／17918）。（2）高危因素：有子宫手术史者占81％（38／47），本次妊娠合并前置胎盘者占30％（14／47），合并子宫肌瘤者占11％（5／47），有产后出血史者占11％（5／47）。（3）诊断：47例胎盘植入患者中，发生在中孕期17例，其中产后B超确诊胎盘植入12例，临床确诊5例；发生在晚孕期30例，其中病理确诊8例，产后B超确诊2例，临床确诊20例。（4）治疗：中孕期患者刮宫术治疗有效率为43％（6／14），子宫动脉栓塞术治疗有效率为100％（11／11）；晚孕期患者刮宫术治疗有效率为21％（6／29），宫腔纱布填塞术治疗有效率为87％（13／15），子宫动脉栓塞术治疗有效率为4／4。结论胎盘植入发生的高危因素主要有子宫手术史，其次是前置胎盘、合并子宫肌瘤及产后出血史；胎盘植入的诊断以临床诊断为主，B超对产后诊断有重要价值；子宫动脉栓塞术是治疗胎盘植入的一种行之有效的方法。Objective To explore the clinical characters, diagnosis and treatment methods of placenta accreta. Methods A retrospective analysis was made of 47 cases of placenta accreta admitted during May 1997 to May 2007 into Peking Union Medical College Hospital. They included 17 cases in the second trimester and 30 cases in the third. Results Among all the patients, the incidence of placenta accreta was 0. 262% （47/17 918）. Most of these cases（ 81% ,38/47 ）experienced a uterine procedure. 30% （14/47）of the cases were found with placenta previa and 11% （5/47） with myoma in the current pregnancy. 11% （5/47） of all the cases suffered postpartum hemorrhage. In the 17 cases in the second trimester, 12 were diagnosed by uhrasonography and 5 by clinical evidence . While in the 30 cases in the third trimester, 8 were diagnosed by biopsy, 2 by uhrasonography, and 20 by clinical evidence. 45 cases were cured by conservative treatment, which included dilatation and curettage, uterine artery embolization （UAE） with or without methotrexate （ MTX）, tamping B-lynch suture, singly with MTX, and mifepristone. Only 2 cases received cesarean hysterectomy. Conclusions The incidence of placenta accreta seems on the rise. The incidence in the second trimester is higher than that in the third. In the second trimester, most cases can be diagnosed by uhrasonography after labor, and presently UAE is the best conservative management. While in the third trimester clinical evidence is the most frequent diagnostic approach. A majority of the cases could be cured by conservative therapies, which help them avoid a hysterectomy.

关 键 词：胎盘 侵入性 栓塞 治疗性 妊娠中期 妊娠末期 危险因素 

分 类 号：R686[医药卫生—骨科学]