摘要
目的探讨应用胎盘植入性疾病(placenta accreta spectrum disorders,PAS)产前超声分级系统评估凶险性前置胎盘病例手术风险的价值。方法应用PAS产前超声分级系统回顾性分析2018年9月至2020年6月在首都医科大学附属北京妇产医院收治的凶险性前置胎盘患者32例,根据此分级系统将患者分成四组:PAS 0级、PAS 1级、PAS 2级、PAS 3级。结果所有患者分娩方式均为剖宫产手术,其中1例切除子宫,31例保留子宫。PAS 0级13例(40.6%),PAS 1级5例(15.6%),PAS 2级11例(34.4%),PAS 3级3例(9.4%);四组间患者年龄、末次超声检查孕周比较,差异均无显著性(P>0.05);四组间患者既往剖宫产次数、胎盘植入类型比较,差异有显著性(P<0.05)。PAS 0级和PAS 1级患者平均出血量低于PAS 2级、PAS 3级,PAS 0级和PAS 1级患者平均自体输血量、悬浮红细胞、冰冻血浆水平低于PAS 2级,PAS 2级、PAS 3级患者的平均手术时间较PAS 0级和PAS 1级的时间长,差异均有显著性(P<0.05)。除采用剖宫产手术常规止血措施外,PAS 0级和1级的患者中仅1例(5.6%,1/18)PAS 0级采用宫腔填纱止血,而PAS 2级、3级患者全部采用辅助止血措施,其中8例(57.1%,8/14)采用腹主动脉球囊,2例(14.3%,2/14)术后行双侧子宫动脉栓塞术,1例(7.1%,1/14)因胎盘植入范围太广而无法保留子宫,遂切除子宫。结论PAS产前超声分级系统在凶险性前置胎盘患者的术前评估中具有理想的应用价值,较好地预测了患者手术出血量及子宫切除风险,为术前制订手术方案提供了可靠的影像学依据;对于PAS 2级和PAS 3级患者如拟行保留子宫的手术方案,应充分预估人工剥离胎盘后子宫胎盘剥离面出血与子宫肌层修补过程中的出血量,充分备血,做好有效的止血方案,一旦威胁到产妇的生命安全,需紧急切除子宫。
Objective To explore the value of prenatal ultrasound staging system for placenta accreta spectrum(PAS)disorders in assessing the surgical risk of pernicious placenta previa.Method A retrospective analysis of 32 patients with pernicious placenta previa who visited our hospital from September 2018 to June 2020 was performed using PAS prenatal ultrasound staging system.Pregnant women were divided into 4 groups according to PAS ultrasound staging system:PAS 0,PAS 1,PAS 2,PAS 3.Result There were 13 cases(40.6%)with PAS 0,5 cases(15.6%)with PAS 1,11 cases(34.4%)with PAS 2 and 3 cases(9.4%)with PAS 3.There were no significant differences in age and the last ultrasonic examination gestational weeks among 4 groups(P>0.05).There were significant difference in the number of cesarean section and the type of placenta implantation among 4 groups(P<0.05).The average blood loss of PAS 0 and PAS 1 was lower than that of PAS 2 and PAS 3.The average transfution volume of the autologous blood,suspended red blood cell and fresh frozen plasma of PAS 0 and PAS 1 were lower than that of PAS 2.The average operation time of PAS 2 and PAS 3 was longer than that of PAS 0 and PAS 1.In addition to routine hemostasis in caesarean section,only 1 case(5.6%,1/18)was filled with uterine gauze in the group of PAS 0 and PAS 1.All the patients with PAS 2 and PAS 3 were treated with auxiliary hemostasis,among which,8 cases(57.1%,8/14)used abdominal aortic balloon,2 cases(14.3%,2/14)underwent bilateral uterine artery embolization,and 1(7.1%,1/14)underwent hysterectomy because the placental implantation was too extensive to preserve the uterus.Conclusion Prenatal ultrasound staging system for PAS has ideal application value in preoperative assessment of pernicious placenta previa,and better predicts intraoperative bleeding volume and hysterectomy risk of patients,providing a reliable imaging basis for making the operation scheme.For PAS 2 and PAS 3 cases,if uterus is retained,it is necessary to fully estimate the amount of bleeding in uteroplacental surface after artificial placenta separation and myometrium repair,and make adequate blood preparation and effective hemostasis schemes.Once the life of the women is threatened,the uterus needs to be excised urgently.
作者
崔静静
王莉
玄英华
吴青青
王晶晶
刘晓巍
马玉庆
韩吉晶
马雪松
岳嵩
郭翠霞
Cui Jingjing;Wang Li;Xuan Yinghua;Wu Qingqing;Wang Jingjing;Liu Xiaowei;Ma Yuqing;Han Jijing;Ma Xuesong;Yue Song;Guo Cuixia(Department of Ultrasound,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China;Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)
出处
《中国医刊》
CAS
2021年第4期412-416,共5页
Chinese Journal of Medicine
基金
北京市卫生健康科技成果和适宜技术推广项目(BHTPP202044)
北京市医院管理中心“登峰”计划专项经费资助(DFL20151302)。
关键词
胎盘植入性疾病
产前超声分级系统
凶险性前置胎盘
预测
Placenta accreta spectrum disorders
Prenatal ultrasound staging system
Pernicious placenta previa
Forecast
作者简介
通信作者:王莉,E-mail:wangli1971@ccmu.edu.cn。
