凶险性前置胎盘临床分级诊治方案探讨  

Research on clinical grading diagnosis and treatment of pernicious placenta previa

作　　者：辛思明[1] 郑九生[1] 贺晓菊[1] 刘凌芝[1] 蔡小凤[1] XIN Siming;ZHENG Jiusheng;HE Xiao-ju(Jiangxi Maternal and Child Health Care Hospital,Nanchang 330006,Jiangxi,China)

机构地区：[1]江西省妇幼保健院产科,南昌330006

出　　处：《江西医药》2018年第7期653-656,共4页Jiangxi Medical Journal

基　　金：江西省科技计划项目;编号20151BBG70098

摘　　要：目的探讨凶险性前置胎盘临床分级诊疗方法,以减少产后出血量、降低子宫切除率和泌尿系统损伤率。方法选取2011年1月-2013年12月在我院住院分娩凶险性前置胎盘孕妇130例作为对照组,依据术中所见并结合术后病理学检查分为Ⅰ级、Ⅱ级、Ⅲ级和Ⅳ级,选取2014年1月至2016年12月我院住院分娩凶险性前置胎盘孕妇130例作为研究组,术前分级诊断依据彩色超声多普勒检查分为Ⅰ级、Ⅱ级、Ⅲ级和Ⅳ级。术后诊断以术中所见并结合术后病理学检查为准,比较两组术中出血量、子宫切除率和泌尿系统损伤率。结果⑴两组孕妇均显示临床诊断分级越高,出血量越多;⑵同一临床分级患者,对照组出血量均多于研究组;⑶对照组总体出血量、子宫切除率及输尿管损伤率显著多于研究组;⑷两组膀胱损伤率无明显差异。结论术前对凶险性前置胎盘进行规范临床分级诊断,制订规范化治疗方案能有效减少术中出血量,降低子宫切除率和输尿管损伤率。Objective To explore the clinical grading diagnostic method and treatment of pernicious placenta previa,reduce the amount of postpartum hemorrhage,reduce the rates of hysterectomy and urinary system damage. Methods 130 pregnant women with pernicious placenta previa were selected from January 2011 to December 2013 in our hospital as control group,then they were divided into grade Ⅰ,Ⅱ,Ⅲ and Ⅳ according to intraoperative findings and postoperative pathological examination. The other 130 pregnant women with placenta previa from January 2014 to December 2016 in our hospital as study group. The preoperative grading diagnosis were divided into grade Ⅰ,Ⅱ, Ⅲand Ⅳ based on color Doppler ultrasound examination,and the postoperative diagnosis was based on the intraoperative findings and pathological findings after operation. Then we compared the amount of bleeding,the rates of hysterectomy and urinary damage between the two groups. Results ⑴Between the two groups,the higher grade of clinical diagnosis,the more bleeding volume;⑵In the same clinical grading group,the amount of bleeding in the control group was more than that in the study group;（3）The total bleeding volume,hysterectomy rate and ureteral injury rate in the control group were significantly higher than those in the study group;⑷There was no significant difference in bladder injury rate between two groups. Conclusion It was effective to reduce the amount of bleeding,reduce the rate of hysterectomy and ureter injury by standardizing the clinical grading diagnosis of pernicious placenta previa and formulating standardized treatment plan.

关 键 词：凶险性前置胎盘 胎盘植入 临床分级诊断 子宫切除术 泌尿系统损伤 

分 类 号：R714.2[医药卫生—妇产科学]