超声在植入性凶险型前置胎盘中的应用价值  

Diagnostic value of ultrasound in pernicious placenta previa with implantation

作　　者：高传芬[1] 王玲[1] 何丹青[1] GAO Chuan-fen;WANG Ling;HE Dan-qing(Ultrasound Department of The First Affiliated Hospital of Medical University of Anhui,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院超声科

出　　处：《吉林医学》2019年第6期1218-1221,共4页Jilin Medical Journal

摘　　要：目的:评价超声在植入性凶险型前置胎盘中的应用价值。方法:回顾性分析72例凶险型前置胎盘合并胎盘植入患者的临床资料,所有患者均在产前行胎儿超声检查,均行再次剖宫产术或(和)子宫切除术。根据术中所见胎盘与子宫肌层致密粘连无缝隙或经产后组织病理学检查有绒毛侵入子宫肌层者为胎盘植入,宫壁胎盘植入处仅存浆膜层或穿透浆膜层为穿透肌层组(22例),其余为植入肌层组(50例)。分析比较两组患者的超声表现(包括胎盘后间隙消失、胎盘内血窦或虫蚀样回声、胎盘后血流丰富、膀胱壁毛糙不连续和超声未提示的胎盘植入)及临床特征[手术方式(全/次全子宫切除术、子宫修补术、膀胱修补或造瘘术)及各种妊娠合并症(妊娠糖尿病/贫血/子痫/失血性休克等)]。结果:两组患者施行子宫切除术占比:植入肌层组11/50(22.0%)、穿透肌层组19/22(86.4%),χ^2=26.040,P=0.000;施行膀胱修补或造瘘术占比:植入肌层组0/50(0.0%)、穿透肌层组6/22(27.3%),χ^2=12.527,P=0.001。两种手术率在植入肌层组及穿透肌层组中差异均有统计学意义(P<0.05),穿透肌层组的子宫切除及膀胱切除或修补的手术率更高。两组患者胎盘植入超声共同表现为胎盘后间隙消失,胎盘内血窦或虫蚀样回声,胎盘后方血流丰富;穿透肌层组如侵及膀胱,超声还表现为子宫膀胱界面消失,膀胱壁毛糙不连续。结论:超声根据胎盘后间隙的消失、胎盘内血窦或虫蚀样回声等特征可诊断胎盘植入,还能根据子宫膀胱界面消失提示穿透性胎盘植入。Objective To discuss the diagnostic value of ultrasound in pernicious placenta previa with different degrees of implantation.Method 72 cases of pernicious placenta previa with implantation were analysed retrospectively.All of them were performed on prenatal ultrasound(after 28 weeks′gestation).Implantation relied on surgery and pathology .According to the degree of implantation,they were divided into two groups,50 cases in the placenta increta group,and 22 cases in the placenta percreta group.The ultrasonographic and clinical features of the two groups were analysed. Results Two groups of patients underwent hysterectomy:the placenta increta group 11/50 (22.0%),the placenta percreta group 19/22 (86.4%),chi square value 26.040 and P=0.000.Two groups of patients underwent hysterectomy and bladder repair:the placenta increta group 0/50 (0.0%),the placenta percreta group 6/22 (27.3%),chi square value 12.527 and P=0.001 .There was significant difference in the two groups(P<0.05).The common sonographic characteristics of placental implants including:the disappearance of the posterior placental space,placenta lacuna,and doppler abnormality.The placenta percreta group also included loss of uterine serosa and irregular border between the bladder and myometrium.Conclusion Implantation can be diagnosed according to the disappearance of the posterior placental space,placenta lacuna,doppler abnormality and irregular border between the bladder and myometrium.Especially the irregular border between the bladder and myometrium can be used as an important reference for the diagnosis of placenta percreta.

关 键 词：凶险型前置胎盘 胎盘植入 超声诊断 

分 类 号：R714.2[医药卫生—妇产科学] R445.1[医药卫生—临床医学]