凶险型前置胎盘并胎盘植入的诊治研究

目的探讨凶险型前置胎盘并胎盘植入的诊断及如何减少手术出血量和降低子宫切除率的方法。 方法收集广东省佛山市妇幼保健院自2008年1月至2012年10月收治的52例凶险型前置胎盘患者的临床资料，对胎盘植入发生率、诊断和处理方法进行回顾性分析。 结果(1)52例凶险型前置胎盘并胎盘植入19例，发生率36.5%；穿透性胎盘植入8例，发生率15.4%。(2)术前彩色多普勒超声诊断胎盘植入10例，诊断率52.6%。(3)当有胎盘植入侵及膀胱时，膀胱镜下观察膀胱黏膜下血管有明显增生扩张。(4)保留子宫48例(占92.3%)，切除子宫4例(占7.7%)。 结论(1)彩色多普勒检查和膀胱镜检查可提高凶险型前置胎盘的诊断率。(2)选择胎盘边缘切口结合结扎子宫动脉上行支、髂内动脉和子宫B-Lynch缝合术可有效地减少术中出血，降低子宫切除率。

Diagnosis and treatment of pernicious placenta previa complicated with placenta accrete

ObjectiveTo explore the diagnosis and treatment of pernicious placenta previa complicated with placenta accrete, in order to decrease operation hemorrhage and hysterectomy rate. MethodsWe conducted a retrospective study at 52 pregnant women with pernicious placenta previa, who were treated at the Maternity and Child Health Care Hospital of Foshan City from January 2008 to October 2012. This study reviewed the incidence rates, diagnosis and treatment. Results(1) Among the 52 patients, 19 were diagnosed pernicious placenta praevia with placenta implantation; the incidence rate was 36.5%; while 8 patients were pernicious placenta praevia with placenta percreta, which incidence rate was 15.4%. (2) Ten patients were diagnosed by color Doppler ultrasound before operation; the diagnosis rate was 52.6%. (3) Vascular hyperplasia expansion of bladder mucosa were seen through cystoscopy in placenta accrete invade in the bladder. (4) Hysterectomy was used in 4 cases(7.7%), and 48 cases(92.3%) were preserve utero. Conclusions(1) Color Doppler ultrasonography and cystoscopy can improve the diagnosis rate of pernicious placenta previa. (2) It is the effective way to reduce bleeding and hysterectomy rate of pernicious placenta previa cases applying appropriate incision of cesarean section on placental edge combining ligating ascending uterine artery, internal iliac artery and B-Lynch suture.