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中华妇幼临床医学杂志(电子版) ›› 2013, Vol. 09 ›› Issue (01) : 44 -47. doi: 10.3877/cma.j.issn.1673-5250.2013.01.010

所属专题: 经典病例 文献

论著

胎盘植入的诊治方法:附29例临床分析
孙琰1, 肖建平1,*,*(), 赵丽1, 杨月芬1   
  1. 1. 214002 江苏 无锡,南京医科大学附属无锡妇幼保健院
  • 收稿日期:2012-10-03 修回日期:2012-11-03 出版日期:2013-02-01
  • 通信作者: 肖建平

Diagnosis and Treatment of Placenta Accreta: Clinical Analysis of 29 Cases

Yan SUN1, Jian-ping XIAO1(), Li ZHAO1, Yue-feng YANG1   

  1. 1. Wuxi Materiality and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, Jiangsu Province, China
  • Received:2012-10-03 Revised:2012-11-03 Published:2013-02-01
  • Corresponding author: Jian-ping XIAO
  • About author:
    Corresponding author: XIAO Jian-ping, Email:
引用本文:

孙琰, 肖建平, 赵丽, 杨月芬. 胎盘植入的诊治方法:附29例临床分析[J]. 中华妇幼临床医学杂志(电子版), 2013, 09(01): 44-47.

Yan SUN, Jian-ping XIAO, Li ZHAO, Yue-feng YANG. Diagnosis and Treatment of Placenta Accreta: Clinical Analysis of 29 Cases[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2013, 09(01): 44-47.

目的

探讨胎盘植入的诊断和治疗方法。

方法

回顾性分析2008年1月至2010年12月本院收治的29例胎盘植入患者的临床病历资料。胎盘植入分度标准参照《诊断病理学》(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准)。

结果

本组29例患者中,在分娩即刻及分娩后确诊为胎盘植入的患者为89.66%(26/29),仅3例(10.34%)为分娩前确诊。本组Ⅱ°以上胎盘植入患者占72.41%(21/29),Ⅰ°为27.59%(8/29)。本组仅8例(27.59%)胎盘植入患者根据病史及体征确诊,另外21例(72.41%)借助彩色多普勒超声确诊;3例分娩前确诊断的患者中,2例借助MRI确诊。本组因胎盘植入导致的产后出血(PPH)发生率高达82.76%(24/29),出血量超过1000 mL为16例(55.17%,16/29),其中3例(12.50%,3/24)因PPH行急诊子宫切除术,2例(8.33%,2/24)行局灶切除术。24例87.5%(21/24)综合治疗后,87.5%(21/24)植入胎盘组织于产后3个月内排出,另3例在产后3~6月内排出。本组无一例产妇死亡。

结论

彩色多普勒超声联合MRI可提高胎盘植入的分娩前、后确诊率。彩色多普勒超声跟踪观察将有助于动态判断胎盘植入的转归。手术及药物联合治疗有助于提高胎盘植入患者保守治疗的成功率。

Objective

To investigate the diagnosis and treatment of placenta accrete.

Methods

From January 2008 to December 2010, a total of 29 cases clinical records of women with placenta accreta in Wuxi Materiality and Child Health Hospital Affiliated to Nanjing Medical University were admitted to analysis by retrospective analysis methods. This study was approved by the ethics committee of Wuxi Materiality and Child Health Hospital. The standard of diagnosis and classification of placenta accreta are followed by the guideline of Diagnostic Pathology.

Results

Of 29 patients in this study, 26 cases (89.66%) were diagnosed with placenta accreta during or after delivery, only 3 cases (10.34%) were diagnosed before delivery, 2 cases of them were diagnosed by MRI. Among them 8 cases(8/29) were diagnosed of grade Ⅰ of placenta accreta, while the other majority (21 patients, 72.41%) were diagnosed with grade Ⅱ or Ⅲ. In this study, only 8 cases (27.59%) were diagnosed by medical history and symptoms, the other 21 cases(72.41%) were diagnosed by color Doppler ultrasound.The incidence of postpartum hemorrhage (PPH) caused by placenta accreta was as high as 82.76% (24/29). Of them, blood loss volume of 16 cases (55.17%) was more than 1000 mL, 3 cases (12.50%, 3/24) due to PPH underwent emergency hysterectomy and 2 cases (8.33%, 2/24) were underwent supracervical hysterectomy. After treatment with conservative treatment among 24 cases with placenta accreta , there were 87.5%(21/24)placenta tissues were discharged in 3 months, the others' placenta tissues were discharged between 3 to 6 months. There was no maternal death in this group.

Conclusions

Placenta accreta can be accurately diagnosed by color Doppler ultrasound or MRI. Doppler tracking will help to dynamically determine the outcome of placenta accreta. The combination of surgery and medical therapy can improve the success rate of conservative treatment to patients with placenta accreta.

表1 29例胎盘植入患者诊断措施及结果比较 [n(%)]
Table 1 Comparison of diagnosis measures and results among 29 cases maternal with placenta accreta [n(%)]
表2 胎盘植入程度与产后24 h出血量比较[mL,n(%)]
Table 2 Comparison of degrees of placenta accreta and blood loss volumes [mL,n(%)]
表3 24例胎盘植入保守治疗措施分析[n(%)]
Table 3 Clinical analysis of 24 cases placenta accreta with conservative treatment[n(%)]
[1]
Zhang YP Liu XH. Postpartum haemorrhage: Comprehensive guide to evaluation, therapy, and surgical operation for postpartum haemorrhage[M].Beijing: People's Medical Publishing House, 2008,178.
[2]
Garmi1 G, Salim R. Epidemiology, etiology, diagnosis, and management of placenta accrete[J]. Obstet and Gynecol Int, 2012, 2012:873-929.
[3]
Daskalakis G, Anastasakis E, Papantoniou N, et al. Emergency obstetric hysterectomy[J].Acta Obstet Gynecol Scand, 2007,86(2):223-227.
[4]
Baughman WC, Corleville IE, Shah RR. Placenta accrete:Spectrum of US and MR imaging finding[J],RadioGraphies,2008,28(7):1905-1919.
[5]
Liu TH. Diagnostic pathology.2nd [M].Beijing, People's Medical Publishing House,2006.538.
[6]
YangJ, Xu L, Chen CJ, et al. Evaluation of the ultrasound and MRI in diagnosis of placenta accrete [J]. Prog Obstet Gynecol, 2008, 17 (7):530-531.
[7]
Wang WF, Zhong WB, Chen SY. Clinical analysis of placenta accrete [J]. Prog Obstet Gyneco, 2010, 19(6):476-477.
[8]
Lin KQ, Huang XF, Zhang XM, et al. Clinical analysis of 7 cases of hysteroscopic electrosurgery treatment of partial placenta accreta [J].Chin J Obstet Gynecol,2010,45(2):145-147.
[9]
Zhang HW, Chen PX, Wu YL, et al. Clinical analysis of hysteroscopic transcervical resection of residue of placenta[J].BME Clin Med,2007,11(5):376-378.
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