中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2017, Vol. 39 ›› Issue (5): 693-698.doi: 10.3881/j.issn.1000-503X.2017.05.016

• 论著 • 上一篇    下一篇

剖宫产术后植入性前置胎盘的临床及声像图特征分析

刘真真1, 韦瑶1, 王若蛟1, 徐雯1, 石志敏2, 戴晴1()   

  1. 1中国医学科学院 北京协和医学院 北京协和医院超声医学科,北京 100730
    2北京市海淀区妇幼保健院超声科,北京 100080
  • 收稿日期:2017-05-10 出版日期:2017-10-30 发布日期:2017-10-30
  • 作者简介:

    通信作者:戴 晴 电话:010-69155497,电子邮件:qingdai_2000@yahoo.com

Antenatal Sonographic Diagnosis and Clinical Significance of Placenta Previa Accreta after Cesarean Section

Zhenzhen LIU1, Yao WEI1, Ruojiao WANG1, Wen XU1, Zhimin SHI2, Qing DAI1()   

  1. 1Department of Ultrasound,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
    2Department of Ultrasound,Haidian Maternal and Child Health Hospital,Beijing 100080,China
  • Received:2017-05-10 Online:2017-10-30 Published:2017-10-30

摘要:

目的 总结剖宫产术后植入性前置胎盘病例妊娠至晚孕期的临床及声像图特征。方法 回顾性分析2006年1月至2016年12月在北京协和医院产科住院、剖宫产后再次妊娠合并前置胎盘及胎盘植入子宫前壁下段、于晚孕期行剖宫产手术分娩的21例患者的病历资料,总结临床及术前声像图特征,计算超声诊断率。根据手术及病理诊断将患者胎盘植入程度分为胎盘黏连组(n=5)、胎盘植入组(n=12)和胎盘穿透组(n=4),比较临床及超声特征在不同胎盘植入程度组间的分布差异,分析子宫前壁下段胎盘厚度与手术出血量间的相关性。结果 21例患者中,超声提示前置胎盘20例(95.2%),胎盘植入9例(42.9%);声像图特征主要包括胎盘后“透明层”消失(15/18,83.3%),子宫肌层变薄(12/18,66.7%),异常胎盘内腔隙(12/19,63.2%),膀胱壁回声中断(2/18,11.1%),子宫-膀胱血流信号丰富(4/9,44.4%)。子宫肌层变薄(J-T=64.000,P=0.036)、异常胎盘内腔隙的出现率(J-T=74.500,P=0.032)和子宫前壁下段胎盘厚度(U=83.000,P=0.010)在不同胎盘植入程度组间差异有统计学意义。子宫前壁下段胎盘厚度与手术出血量之间存在直线相关关系(r=0.669,P=0.002)。手术出血量在不同胎盘植入程度组间差异有统计学意义(U=118.500,P=0.000)。结论 剖宫产术后植入性前置胎盘的临床和超声影像学具有特征性表现,定量测量子宫前壁下段胎盘厚度可能对临床预后有参考意义。

关键词: 胎盘植入, 前置胎盘, 剖宫产, 超声

Abstract:

Objective To investigate the clinical and antenatal sonographic characteristics of placenta previa accreta after cesarean section. Methods The data of 21 inpatients diagnosed as placenta previa accreta after cesarean section in PUMC Hospital from 2006 to 2016 were retrospectively reviewed. The clinical and ultrasound features were recorded and compared among three placental accreta groups,including placenta accrete group(n=5),increta group(n=12),and percreta group(n=4). The relationship between the placental thickness at the uterine anterior lower segment level and the blood loss of the following cesarean section was tested. Results Of 21 patients,placenta previa was diagnosed by ultrasound in 20 cases(95.2%) and placenta previa accreta was diagnosed in 9 cases(42.9%). Antenatal ultrasound findings included following signs:loss of “clear zone”(15/18,83.3%),myometrial thinning(12/18,66.7%),abnormal placental lacunae(12/19,63.2%),bladder wall interruption(2/18,11.1%),and uterovesical hypervascularity(4/9,44.4%). Myometrial thinning(J-T=64.000,P=0.036),abnormal placental lacunae(J-T=74.500,P=0.032) and the placental thickness at the uterine anterior lower segment level(U=83.000,P=0.010) showed significant difference among different placenta accreta groups. Placental thickness at the uterine anterior lower segment level showed linear correlation with the blood loss of the following cesarean section(r=0.669,P=0.002). The blood loss of the following cesarean section showed significant difference among different placenta accreta groups(U=118.500,P=0.000). Conclusions The clinical and sonographic manifestations of placenta previa accreta after cesarean section show a spectrum of demographic characteristics. The measurement of thickness of placenta at the anterior lower segment may help the evaluation of the clinical prognosis of this special pathology.

Key words: placenta accreta, placenta previa, cesarean section, ultrasonography

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