穿透性胎盘植入产前超声诊断与临床结局对照分析  

Comparative Analysis of Prenatal Ultrasound Diagnosis and Clinical Outcome in Penetrating Placenta

作　　者：杨生旭[1] 欧阳元付 汪荣华[1] 童小燕 Yang Shengxu;Ouyang Yuanfu;Wang Ronghua;Tong Xiaoyan(Department of Ultrasonography,The Second Hospital of Sanming City,Yongan,Fujian 36600)

机构地区：[1]福建省三明市第二医院(福建中医药大学第五临床医学院)超声影像科

出　　处：《现代医用影像学》2019年第12期2572-2576,共5页Modern Medical Imageology

摘　　要：目的:探讨穿透性胎盘植入的声像图特征及其诊断的临床意义。资料与方法:回顾性分析2010年1月~2018年12月在福建省三明市第二医院产前超声检查,临床和病理结果证实为穿透性胎盘植入的病例共14例,分析所有病例的产前超声表现,并与临床结果进行比较。结果:产前超声正确诊断12例(85.71%),漏诊2例(14.29%)。产前超声正确诊断病例资料:⑴临床特点:11例合并剖宫产史,其中6例为两次剖宫产史;孕早期超声检查中1例曾提示瘢痕妊娠,4例可回顾超声图像证实为瘢痕妊娠。⑵声像图特征:均为完全性前置胎盘;胎盘后间隙(胎盘基底部的低回声带)部分或完全消失伴该处肌层消失、血管迂曲、血流信号丰富,探及滋养层血流频谱;胎盘内部及后方多发无回声即胎盘陷窝(奶酪征),陷窝内可见快速射流(沸水征),甚者融合成片并累及宫旁;累及宫颈时宫颈形态消失,血流极丰富;前壁前置胎盘时膀胱受压,膀胱后壁浆膜层强回声带可部分或完全消失。⑶治疗及结局:11例行子宫下段剖宫产术,1例孕16周行全子宫切除术。全部行膀胱镜检查、双侧输尿管双J管植入术;4例膀胱修补术、2例子宫动脉结扎、3例双侧髂内动脉结扎;3例子宫次全切除,8例全子宫切除,1例保留子宫;出血量约1100-15000ml;除1例孕23周胎儿畸形、1例孕16周外,余10例共11个新生儿存活。结论:剖宫产史发现完全性前置胎盘时,应高度警惕胎盘植入,并评估是否为穿透性胎盘植入;穿透性胎盘植入具有典型的超声征象,超声不仅在产前正确诊断,而且在妊娠保守治疗中可以进行动态监测,为决策适当的分娩时机及手术方式提供正确信息,具有重要的临床应用价值。Purpose:To investigate the ultrasonographic features of penetrating placenta implantation and its clinical significance.Materials and Methods:a total of 14 cases of placenta previa diagnosed by prenatal ultrasonography in Fujian Sanming Second Hospital from January 2010 to December 2018 were retrospectively analyzed.All cases were analyzed by prenatal ultrasound and compared with clinical results.Results:Twelve cases(85.71%)were correctly diagnosed by prenatal ultrasound and two cases(14.29%)were missed.The correct diagnosis of cases by prenatal ultrasound:⑴Clinical Features:11 Cases of cesarean section history,of which 6 cases were two Caesarean section history,1 cases of early pregnancy ultrasound examination have been suggested scar pregnancy,4 cases can be reviewed ultrasound image confirmed as scar pregnancy.⑵sonographic Features:all are complete placenta;the posterior placental clearance(low echo band at the base of the placenta)is partially or completely disappeared with the disappearance of the muscle layer,the blood vessel circuitous,the blood flow signal is abundant,and the blood flow spectrum of the trophic layer is found,the internal and posterior multiple non-echo of the placenta is the placenta trap(cheese sign),The most fused into pieces and involved in the palace;When the cervix is involved,the cervical morphology disappears and the blood flow is abundant;the bladder is pressurized during the anterior wall anterior placenta,and the strong echo band of the serous layer in the posterior wall of the bladder can be partially or completely disappeared.⑶Treatment and outcome:11 cases of lower uterine cesarean section,1 cases of 16 weeks of total hysterectomy.All the cystoscopy,bilateral ureteral double J tube implantation,4 cases of bladder repair,2 cases of uterine artery ligation,3 cases of bilateral internal iliac artery ligation,3 cases of total hysterectomy,8 cases of full hysterectomy,1 cases of retaining uterus,bleeding volume of about 1100-15000ml,except 1 cases of 23 weeks of fetal malfor

关 键 词：前置胎盘 穿透性胎盘植入 产前 超声 诊断 治疗 

分 类 号：R71[医药卫生—妇产科学]