【作者】 张超；

【导师】 刘欣燕；

【作者基本信息】 中国协和医科大学 ， 妇产科， 2007， 硕士

【摘要】 目的探讨和分析胎盘植入患者的临床特点、诊断和治疗。方法总结北京协和医院自1997年5月至2007年5月收治的17例中孕期和30例晚孕期(共47例)胎盘植入病例，对胎盘植入的临床特点、诊断和治疗进行回顾性分析。结果1997年5月～2007年5月的10年间我院胎盘植入的总发生率为2.62‰，中孕期发生率为19.32‰，晚孕期发生率为1.76‰。临床特点：有子宫手术史者占80.85％，本次妊娠合并前置胎盘者占29.79％，合并子宫肌瘤者占10.64％，有产后出血史者10.64％。临床表现：胎盘残留伴出血者占61.70％，胎盘残留不伴出血者占38.30％。诊断：中孕期17例，其中通过B超确诊12例，临床确诊5例；晚孕期30例，其中通过病理确诊8例，BUS确诊2例，临床确诊20例。治疗：中孕期刮宫术有效率41.67％，子宫动脉栓塞有效率为100％，晚孕期刮宫有效率为23.08％，宫纱填塞有效率为86.67％，子宫动脉栓塞有效率为100％。结论胎盘植入的发生率有逐年增加趋势，在中孕期的发生率明显高于晚孕期。B超在产前诊断胎盘植入比较困难。中孕胎盘植入诊断以产后B超诊断为主，治疗上子宫动脉栓塞效果好，可以保留子宫，无严重并发症；晚孕期胎盘植入诊断以临床为主，治疗采用手术清除和止血相结合的方法，大多可以保留子宫。更多还原

【Abstract】 Objective To discuss the clinical characters, diagnosis and treatment methods ofplacenta accreta.Methods Retrospective analysis was made in 47cases of placenta accreta from May1997 to May 2007 in Peking Union Medical College Hospital.These cases include 17cases in the second stage of pregnancy and 30 cases in the third trimester.Results During May 1997 to May 2007, the incidence of placenta accreta in ourhospital was 2.62‰.Most of these cases had received one or more dilatation andcurettage, previous cesarean delivery, or myomectomy. Some cases were found withplacenta previa or myoma in the current pregnancy. There were 61.70％of all thecases with hemorrhage. In the 17 cases in the second stage of pregnancy there are 12cases were diagnosed by B-ultrasound and 5 by clinical evidence.While in the 30cases in the third trimester there are 8 cases ware diagnosed by pathology,2 byB-ultrasound and 20 by clinical evidence.45 cases had been cured by conservativetreatment.These methods include dilatation and curettage, uterine arteryembolism(UAE) with or without MTX, package and B-lynch suture, singly withMTX, RU-486. Only 2 cases received cesarean hysterectomy.Conclusion The incidence of placenta accreta is rising.The incidence in the secondstage of pregnancy was higher than that in the third. No cases can be diagnosed byB-ultrasound before birth.In the second stage most cases can be diagnosed byB-ultrasound after labor, and now UAE is the best satisfactory conservativemanagement. While in the third trimester few cases can be diagnosed byB-ultrasound, and clinical evidence is the most frequent diagnostic methods, tampingis one of the best satisfactory conservative management. In our hospital a majority ofthe cases had been cured by conservative therapy which could in turn avoid hysterectomy.更多还原