胎盘植入诊治的临床效果分析

高袁可作为胎盘植入的常规诊断方法曰术前双侧髂内动脉预置球囊可明显减少术中出血袁推迟妊娠终止时间袁提高新生儿质量遥
关键词院胎盘植入曰凶险性前置胎盘曰剖宫产史曰髂内动脉曰球囊
中图分类号院R714.2
文献标识码院A
DOI:10.3969/j.issn.1006-1959.2019.10.040
文章编号院1006-1959渊2019冤10-0122-02
be used as a routine diagnostic method for placenta implantation. The preset internal balloon of the lateral iliac artery can significantly reduce
intraoperative bleeding, delay the termination of pregnancy, and improve the quality of newborns.
second trimester, the previous delivery method and time were collected. The clinical information such as pre-examination, intraoperative blood loss,
hemostasis, placenta implantation, termination of pregnancy, and fetal Apgar 1 min score were statistically analyzed.Results Of the 26 patients, 22
had a central placenta previa, and 20 had a history of previous cesarean section. The accuracy of ultrasound Doppler and magnetic resonance
diagnosis of placenta was not statistically significant ( =0.346); Compared with the preoperative bilateral uterine artery embolization group, the
termination time of pregnancy in the bilateral internal iliac artery balloon preset group was prolonged ( =0.022), and the neonatal asphyxia was
reduced ( =0.000), there was no significant increase in bleeding volume ( =0.194).Conclusion Placental accreta mainly occurs in patients with
central placenta previa, and the history of cesarean section is a high risk factor. Ultrasound Doppler diagnosis of placenta is highly accurate and can
Clinical Analysis of Diagnosis and Treatment of Placenta Accreta
LIU Jing-jing,WANG De-ling
(Department of Obstetrics,Tianjin First Central Hospital,Tianjin 300192,China)
第 32 卷第 10 期
Medical Information May. 2019 Vol. 32 No.10
胎盘植入诊治的临床效果分析
刘晶晶袁王得玲
渊天津市第一中心医院产科袁天津 300192冤
摘要院目的 探讨胎盘植入的高危发病因素尧诊断及治疗遥 方法 选择 2013 年 1 月~2018 年 12 月于天津市第一中心医院经手术
Key words：Placenta accreta;Sinister placenta previa;History of cesarean section;Internal iliac artery;Balloon
胎盘植入（placental accreta）是指胎盘绒毛不同 程度侵入子宫肌层，是一种少见但危重的产科疾病， 可引起严重的产时出血，甚至危及产妇生命。其病因 尚不清楚，子宫手术史、前置胎盘、高龄等都被认为 是高危因素。近年来随着剖宫产的普及，胎盘植入的 发生率高达 1/533[1]。该病初步诊断主要靠彩色超声 多普勒、磁共振等影像学，确诊靠术中所见或术后病 理。控制胎盘植入产时产后出血的方法包括缝合出 血点、宫腔填塞、Bakri 球囊压迫、术前双侧髂内动脉 球囊预置甚至腹主动脉球囊预置，术前/术后双侧子 宫动脉栓塞，甚至髂内动脉栓塞，全子宫或次全子宫 切除术等[2]。本研究回顾性分析胎盘植入患者的临床 资料，探讨该病的高危发病因素、诊断及治疗。 1 对象与方法 1.1 研究对象 选择 2013 年 1 月~2018 年 12 月于天 津市第一中心医院确诊的 26 例胎盘植入患者作为 研究对象。患者均于术前 1 周内行经腹彩色超声多 普勒检查，部分行磁共振检查。采用的控制出血方 式包括术前双侧髂内动脉球囊预置、术前双侧子宫 动脉栓塞、缝扎止血及次全子宫切除术。 1.2 诊断标准 超声预测指标[3]：胎盘部位正常结构紊
确诊的 26 例胎盘植入患者作为研究对象袁收集患者的年龄尧孕次产次尧前次分娩方式及时间尧术前检查方式尧术中出血量尧止血 方式尧胎盘植入部位尧终止妊娠时间尧胎儿 Apgar 1 min 评分等临床信息进行分析遥结果 26 例患者中袁共 22 例中央型前置胎盘袁
20 例合并既往剖宫产史曰超声多普勒与磁共振诊断胎盘植入的准确性比较袁差异无统计学意义渊 =0.346冤曰与术前双侧子宫动 脉栓塞组相比袁双侧髂内动脉球囊预置组的妊娠终止时间延长渊 =0.022冤袁新生儿窒息情况减轻渊 =0.000冤袁出血量无明显增加 渊 =0.194冤遥 结论 胎盘植入主要发生于中央型前置胎盘患者袁既往剖宫产史为其高危因素曰超声多普勒诊断胎盘植入的准确率
Abstract：Objective To investigate the high-risk factors, diagnosis and treatment of placenta accreta.Methods 26 patients with placenta-preserved
patients who were diagnosed in the First Central Hospital of Tianjin from January 2013 to December 2018 were selected as subjects. The age, the