植入性胎盘16例临床分析

    Clinical analysis of 16 cases of placenta accreta

    • 摘要: 目的:探讨植入性胎盘发病的相关因素、诊断及治疗。方法:对16例植入性胎盘患者进行回顾性分析及复习文献。其中7例行急症子宫切除;保守治疗9例,其中4例病灶楔形切除局部缝合止血,1例子宫腔填塞纱布条,3例行选择性子宫动脉灌注加栓塞术,1例保守治疗失败。结果:共分娩4 802例,发生植入性胎盘16例,发生率为1/300。16例中前置胎盘10例,剖宫产史4例,≥ 3次人工流产史4例,2次人工流产史11例。无产妇死亡。结论:植入性胎盘的发生与前置胎盘、剖宫产史、多次人工流产史有关,产前诊断是改善其预后的关键,当植入性胎盘并发致命性大出血时需行子宫切除,对部分非急症且有生育要求的患者可行保守治疗。

       

      Abstract: Objective: To discuss the etiology,diagnosis and treatment of placenta accreta.Methods: Sixteen placenta accreta cases were analyzed retrospectively and the relative literature was reviewed.Seven of the sixteen cases received emergency hysterectomy,four cases were treated with sature and compression hemostasis,one case was performed intrauterine pack with gauze for hemostasis,three cases received uterine artery perfusion plus embolism treatment and one case failed in conservative treatment.Results: Of the 4802 delivery cases,placenta accreta occurred in 16 cases,with an incidence rate of 1:300.Among the 16 cases,placenta previa was observed in 10 cases and previous cesarean delivery in 4 cases;4 cases were found to have more than 3 times of induced abortion and 11 cases had 2 times of induced abortion.No one died.Conclusions: The related risk factors include placenta previa,previous cesarean delivery and multiple induced abortion.Early prenatal diagnosis of placenta accreta is important for the prognosis of the disease.Emergency hysterectomy is usually inevitable for cases with serious hemorrhage;conservative treatment is usually adopted to cases of non-emergency and women with the desire of procreation.

       

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