摘要
目的总结中孕期胎盘植入的诊治经验。方法回顾性分析了2002年1月至2010年1月在北京协和医院就诊的31例中孕期胎盘植入患者的临床资料,总结患者的诊断经过及治疗选择和方法。结果 31例患者中,1例(3.2%)在分娩前经B超提示可疑胎盘植入,30例(96.8%)分娩前B超未发现异常;12例(38.7%)于分娩后随诊期间发现。14例患者分娩后再次行刮宫术,其中6例(42.9%)有效,8例无效后转行子宫动脉栓塞术(UAE)。13例患者直接行UAE,共21例患者行UAE,其中19例(90.5%)治疗有效,1例栓塞后β-人绒毛膜促性腺激素(β-HCG)5个月未正常行开腹病灶切除术,1例β-HCG轻微上升后失访。3例患者行宫腔镜检查,2例在宫腔镜下行病灶清除术,1例直接行宫腔镜检查确诊后行病灶切除术,均治疗有效。1例患者阴道分娩过程中出现出血性休克,急诊行开腹小剖宫术。31例患者中,13例分娩过程中发生大出血,其中2例发生失血性休克;3例次发生产后出血,行UAE后可确切止血。无1例切除子宫。结论中孕期胎盘植入通常在胎儿娩出后诊断,存在滞后性,应重视引产后的随诊以及时发现胎盘植入的可能。中孕期胎盘植入的治疗应以保守性治疗为主,UAE是一种有效的止血及治疗方法。
Objective To summarize our experiences in the diagnosis and treatment of placenta accreta in the second trimester of pregnancy.Methods We retrospectively analyzed the clinical data of 31 patients were admitted to Peking Union Medical College Hospital with placenta accreta in the second trimester of pregnancy from January 2002 to January 2010.Results Among 31 cases,one case（3.2%）was suspected to be with placenta accreta by ultrasound examination and 30 cases（96.8%）were normal before delivery.Placenta accreta was identified during follow-up in 12 cases（38.7%）after delivery.Fourteen patients underwent curettage again after delivery,which was effective in 6 patients（42.9%）and failed in 8 patients,in whom uterine artery embolization（UAE）was further applied.Thirteen patients underwent UAE without curettage.In total,21 cases underwent UAE,which was effective in 19 patients（90.5%）;one patient with abnormal β-human chorionic gonadotropin（β-HCG）5 months after embolization underwent lesion resection and one case with slightly increased β-HCG were lost to follow-up.Hysteroscopy was effective in 3 patients,of whom two patients underwent lesion resection by hysteroscopy and one case who was suspected to be with trophoblastic disease by ultrasonography before surgery and confirmed to be placenta accreta during hysteroscopy examination underwent lesion resection.One case experienced hemorrhagic shock during vaginal delivery and underwent emergency laparotomy.Among all these 31 patients,massive hemorrhage occurred in 13 cases during delivery and hemorrhagic shock in 2 cases.Three cases had postpartum hemorrhage and stopped bleeding after UAE.None needed hysterectomy.Conclusions Placenta accreta in the second trimester of pregnancy is usually diagnosed after childbirth,which may be delayed in some cases.Therefore,special attention should be paid to this disease during follow-up.Conservative treatment was the main therapy of placenta accreta in the second trimester of pregnancy.UAE is effective in stopping bleeding.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2010年第5期501-504,共4页
Acta Academiae Medicinae Sinicae
关键词
胎盘植入
中孕期
子宫动脉栓塞
诊断
治疗
placenta accreta
second trimester of pregnancy
uterine artery embolization
diagnosis
treatment
