中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2014年
19期
3450-3455
,共6页
前置胎盘%剖宫产术%胎盘植入
前置胎盤%剖宮產術%胎盤植入
전치태반%부궁산술%태반식입
Placenta previa%Cesarean section%Placenta accreta
目的：探讨以子宫下段横行环状压迫缝合术联合子宫下段修补术为主的子宫外压迫止血法在凶险型前置胎盘伴胎盘植入剖宫产术中的止血效果及临床应用价值。方法收集广东省韶关市粤北人民医院自2012年1月至2014年6月收治的46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、处理方法及随诊情况进行回顾性分析。结果（1）46例凶险型前置胎盘中并发胎盘植入17例，发生率36.96%；穿透性胎盘植入9例，发生率19.57%。（2）术前彩色多普勒超声诊断胎盘植入7例，诊断率70.00%（7/10）；术前行MR检查诊断胎盘植入8例，诊断率为88.89%。（3）保留子宫38例（82.61%），切除子宫8例，子宫切除率17.39%。（4）术后42～61 d随访8例胎盘植入保留子宫患者，均恶露干净、子宫复旧良好。结论彩色多普勒检查和盆腔MR 检查可提高凶险型前置胎盘伴胎盘植入的诊断率；剖宫产术中采用以子宫下段横行环状压迫缝合术联合子宫下段修补术为主的子宫外压迫止血法，可迅速有效地减少剖宫产术中出血量，缩短手术时间，降低子宫切除率。
目的：探討以子宮下段橫行環狀壓迫縫閤術聯閤子宮下段脩補術為主的子宮外壓迫止血法在兇險型前置胎盤伴胎盤植入剖宮產術中的止血效果及臨床應用價值。方法收集廣東省韶關市粵北人民醫院自2012年1月至2014年6月收治的46例兇險型前置胎盤患者的臨床資料，對胎盤植入髮生率、診斷、處理方法及隨診情況進行迴顧性分析。結果（1）46例兇險型前置胎盤中併髮胎盤植入17例，髮生率36.96%；穿透性胎盤植入9例，髮生率19.57%。（2）術前綵色多普勒超聲診斷胎盤植入7例，診斷率70.00%（7/10）；術前行MR檢查診斷胎盤植入8例，診斷率為88.89%。（3）保留子宮38例（82.61%），切除子宮8例，子宮切除率17.39%。（4）術後42～61 d隨訪8例胎盤植入保留子宮患者，均噁露榦淨、子宮複舊良好。結論綵色多普勒檢查和盆腔MR 檢查可提高兇險型前置胎盤伴胎盤植入的診斷率；剖宮產術中採用以子宮下段橫行環狀壓迫縫閤術聯閤子宮下段脩補術為主的子宮外壓迫止血法，可迅速有效地減少剖宮產術中齣血量，縮短手術時間，降低子宮切除率。
목적：탐토이자궁하단횡행배상압박봉합술연합자궁하단수보술위주적자궁외압박지혈법재흉험형전치태반반태반식입부궁산술중적지혈효과급림상응용개치。방법수집광동성소관시월북인민의원자2012년1월지2014년6월수치적46례흉험형전치태반환자적림상자료，대태반식입발생솔、진단、처리방법급수진정황진행회고성분석。결과（1）46례흉험형전치태반중병발태반식입17례，발생솔36.96%；천투성태반식입9례，발생솔19.57%。（2）술전채색다보륵초성진단태반식입7례，진단솔70.00%（7/10）；술전행MR검사진단태반식입8례，진단솔위88.89%。（3）보류자궁38례（82.61%），절제자궁8례，자궁절제솔17.39%。（4）술후42～61 d수방8례태반식입보류자궁환자，균악로간정、자궁복구량호。결론채색다보륵검사화분강MR 검사가제고흉험형전치태반반태반식입적진단솔；부궁산술중채용이자궁하단횡행배상압박봉합술연합자궁하단수보술위주적자궁외압박지혈법，가신속유효지감소부궁산술중출혈량，축단수술시간，강저자궁절제솔。
Objective To evaluate the hemostatic effect of transverse annular compression sutures combined surgical repair in the lower uterine segment and its value on clinical application to control postpartum Hemorrhage at cesarean delivery for pernicious placenta previa with placenta accreta. Methods We conducted a retrospective study at 46 pregnant women with pernicious placenta previa, who were treated at the Affiliated Yuebei People's Hospital of Shantou University Medical College from January 2008 to June 2012. This study reviewed the incidence rates, diagnosis and treatment. Results Among the 46 patients, 17 were diagnosed pernicious placenta praevia with placenta accreta; the incidence rate was 36.5%;while 9 patients were pernicious placenta praevia with placenta percreta, which incidence rate was 19.57%. Ten patients were diagnosed by color Doppler ultrasound before operation;the diagnosis rate was 70.00%(7/10);Eight patients were diagnosed by magnetic-resonance before operation;the diagnosis rate was 88.89%(8/9). Hysterectomy was used in 8 cases (17.39%), and 38 cases (82.61%) were preserve utero. Eight postoperative patients of pernicious placenta praevia with placenta accreta were followed up to 42-61 days, not only their lochia all disappeared, but uterine instauration was good. Conclusion Color Doppler ultrasonography and magnetic-resonance can improve the diagnosis rate of pernicious placenta previa with placenta accreta. It is the effective way to reduce bleeding,operating time and hysterectomy rate of pernicious placenta previa with placenta accreta cases applying transverse annular compression sutures combined surgical repair in the lower uterine segment.
