凶险性前置胎盘术前评估及手术诊治研究现状  

Current status of preoperative evaluation and surgical treatment on patient with pernicious placenta previa

作　　者：陈代娟 徐金凤 田园 王晓东 彭冰 Chen Daijuan;Xu Jinfeng;Tian Yuan;Wang Xiaodong;Peng Bing(Department of Obstetrics and Gynecology,Key Laboratory of Birth Defects and Related Diseases of Women and Children,Ministry of Education,West China Second University Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川大学华西第二医院妇产科、出生缺陷与相关妇儿疾病教育部重点实验室,成都610041

出　　处：《中华妇幼临床医学杂志（电子版）》2020年第6期634-640,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：四川省科技厅应用基础研究项目(2018JY0575);四川省科技厅重点研发项目(2018SZ0265)。

摘　　要：凶险性前置胎盘(PPP)是产科危急重症,可导致孕妇胎盘植入(PA)和术中大出血发生风险增高。国内外迄今尚无统一的针对PPP孕产妇进行病情评估和手术诊治的规范化指南,亦无统一的手术治疗流程或方式推荐。对PPP高危孕产妇,尽早明确诊断,进行病情评估,采取适当术式择期终止妊娠,了解PPP手术相关并发症,减少或防止严重并发症发生,一旦发生,则采取积极、有效治疗措施,对于降低严重产后出血(PPH)发生率、孕产妇死亡率,改善患者远期预后具有重要意义。目前,针对PPP孕产妇治疗的手术方式及术中止血策略发展迅速。笔者拟就PPP的定义、临床诊断、术前病情评估、手术治疗方式选择、术中辅助治疗策略的最新研究现状进行阐述。Pernicious placenta previa(PPP)is a serious obstetric condition resulting in high risk of placenta accreta(PA)and intraoperative massive hemorrhage.Regarding the treatment of PPP,there is no unified standard guideline for the medical condition assessment and surgical treatment at home and abroad,nor is a unified surgical treatment process or method.Early diagnosis,accurate medical condition assessment,elective termination of pregnancy,and grasping the PPP surgery related complications,reducing or preventing the occurrence of serious complications should be performed.Once happened,positive and effective treatment measures for reducing the incidence of severe postpartum hemorrhage(PPH)and maternal mortality,improving the long-term prognosis are of great significance for pregnant women with high-risk of PPP.At present,surgical methods and intraoperative hemostasis of PPP are developing rapidly.The authors intend to elaborate on the latest research status of PPP definition,clinical diagnosis,preoperative medical condition assessment,surgical mode selection and intraoperative adjuvant therapy strategy.

关 键 词：前置胎盘 胎盘 侵入性 剖宫产术 再 止血 手术 产后出血 子宫收缩 子宫切除术 孕产妇 

分 类 号：R714.4[医药卫生—妇产科学]