摘要
目的探讨穿透性胎盘植入的临床特征、诊断与治疗策略。方法收集广州医科大学附属第三医院收治的1例(简称"本例")及文献报道的13例穿透性胎盘植入患者的临床资料,对穿透性胎盘植入的诊断和治疗方法进行回顾性分析。结果 (1)诊断:14例穿透性胎盘植入患者由超声、磁共振成像(MRI)和术后病理确诊。初产妇发生穿透性胎盘植入2例,经产妇12例。(2)治疗:5例全子宫切除,4例次全子宫切除,5例保留子宫(包括本例);"本例"患者先经双侧髂内动脉、子宫动脉造影+药物灌注栓塞术治疗后胎盘未排出,后经宫腹腔镜联合切除病灶,成功保留了子宫。(3)预后情况:1例患者并发上呼吸道感染,1例并发失血性休克,1例因穿透性胎盘植入并子宫浆膜层出血发生腹腔内出血,其余11例无并发症。(4)围产儿预后:12例胎儿存活,2例发生死胎。结论穿透性胎盘植入好发于有剖宫产病史及经产妇患者,彩色多普勒超声、MRI检查及术后病理可提高胎盘植入的诊断率,合理的保守治疗及宫腹腔镜联合切除病灶,可降低子宫切除率。
Objective To explore the clinical features, diagnosis and treatment of placenta percreta. Methods We retrospectively studied the clinical data of 1 patient with placenta percreta in the Third Affiliated Hospital of Guangzhou Medical University and previous 13 cases reports. Results Fourteen cases of patients had been confirmed by B ultrasound, MRI and pathological method. Among the patients, 2 cases were primipara and 12 cases were muhipara. Five cases had panhysterectomy, 4 cases had subtotal hysterectomy, and 4 cases preserved uteri. The patients, admitted in our hospital, received uterine artery embolization angiography and chemotherapy treatment, but the placenta was not discharged. Then we applied the patients with laparoscopy and hysteroscopy treatment to remove the lesions, and saved the utero successfully. For prognosis of 14 patients, 1 patient had respiratory tract infection, 1 patient had hemorrhagic shock, 1 patient had abdominal bleeding induced by placenta invading uterine serosa, and the remaining 11 patients had no complications. Twelve newborns were alive, but two cases resulted in stillbirth. Conclusions Cesarean section and multipara were the risk factors of placenta percreta. Color doppler uhrasonography, MRI and pathological examination can improve the diagnosis. It can decrease the occurrence of hysterectomy by reasonable conservative therapy and laparoscopy with hysteroscopy treatment.
出处
《中华产科急救电子杂志》
2013年第3期52-56,共5页
Chinese Journal of Obstetric Emergency（Electronic Edition）
关键词
胎盘
侵入性
妊娠结局
病例报告
Placenta accrete
Pregnancy outcome
Case reports
