CAJ | 학술논문

目的：评价超声造影对产后胎盘植入的诊断价值。方法对2012年6月至2014年5月四川省人民医院临床怀疑产后胎盘植入的18例患者行超声造影检查，观察病灶在宫腔内的位置、范围、边界及造影剂灌注特点，结合临床和手术病理诊断结果，分析总结胎盘植入超声造影声像图特征。结果18例患者子宫超声造影均可清楚显示胎盘植入病灶内血流灌注情况及其与子宫肌层边界，其中2例表现为注射造影剂后胎盘残留病灶与周边子宫肌层间界限清楚，术后病理证实为胎盘粘连；15例表现为注射造影剂后胎盘残留病灶与周边子宫肌层间界限不清，病灶附着处子宫浆膜层部分连续性欠佳、呈毛刺或锯齿样改变，术后病理证实为胎盘植入；1例表现为残留胎盘附着处子宫肌层和浆膜层连续性中断、造影剂外溢，术后病理诊断为胎盘穿透、子宫破裂。结论超声造影能真实地反映植入胎盘内血流情况，较好地评估胎盘植入的范围和程度。
목적：평개초성조영대산후태반식입적진단개치。방법대2012년6월지2014년5월사천성인민의원림상부의산후태반식입적18례환자행초성조영검사，관찰병조재궁강내적위치、범위、변계급조영제관주특점，결합림상화수술병리진단결과，분석총결태반식입초성조영성상도특정。결과18례환자자궁초성조영균가청초현시태반식입병조내혈류관주정황급기여자궁기층변계，기중2례표현위주사조영제후태반잔류병조여주변자궁기층간계한청초，술후병리증실위태반점련；15례표현위주사조영제후태반잔류병조여주변자궁기층간계한불청，병조부착처자궁장막층부분련속성흠가、정모자혹거치양개변，술후병리증실위태반식입；1례표현위잔류태반부착처자궁기층화장막층련속성중단、조영제외일，술후병리진단위태반천투、자궁파렬。결론초성조영능진실지반영식입태반내혈류정황，교호지평고태반식입적범위화정도。
Objective To evaluate the value of contrast -enhanced ultrasonography on the diagnosis of postpartum placental implantation.Methods With 18 cases of clinically suspected placenta implantation underwent contrast-enhanced ultrasonography in Sichuan Provincial People’ s Hospital from June 2012 to May 2014, the location, extent, boundary of intrauterine lesions, perfusion features of contrast agent were observed. Referred to clinical and postoperative pathological diagnosis, contrast -enhanced ultrasonography features of postpartum placental implantation were analysed.Results 18 cases of uterine contrast -enhanced ultrasonography clearly showed the blood flow perfusion of implanted placenta and boundary to myometrium.2 cases were placenta adhesions confirmed by postoperative pathological diagnosis, which presented with a residual lesion in placenta with a clear boundary to myometrium;15 cases were placenta implantation confirmed by postoperative pathological diagnosis, which presented with a residual placenta surrounded with extremely thin or even discontinuous uterine serosa; 1 case was placenta penetration, uterine rupture confirmed by postoperative pathological diagnosis, which presented with a residual placenta penetrating the uterine serosa and contrast agent spilling out.Conclusion Contrast-enhanced ultrasound can actually reflect the blood flow, range and extent of implanted placenta via the difference of tissue perfusion.