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前置胎盘患者深层植入的临床特征分析 (/HTML )




Clinical characteristics of placenta increta and percreta in patients with placenta previa
LUO Li SUN Qiulei YING Demei WU Xiaohua XIE Rongkai CHEN Zhengqiong  

Department of Gynecdogy and Obstetrics, Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, 400037, China

placenta previa accrete placental invasion placenta increta placenta percreta

目的    探索前置胎盘患者深层植入(肌层植入及穿透性植入)的临床特征从而指导临床治疗并改善临床结局。方法     回顾性分析我院4年间诊断为前置胎盘的患者571例。采用单因素及Logistic回归分析临床特征与深层植入间的关系,采用受试者工作(ROC)曲线评估各临床特征对深层植入的诊断敏感度及特异度。结果     剖宫产次数每增加1次,胎盘深层植入的风险就增加3.433倍,OR=3.433,P<0.01。超声发现胎盘陷窝者、胎盘低回声带模糊或消失者、膀胱子宫间隙血供增加者胎盘深层植入的风险的OR值及P值分别为: OR=5.047, P<0.01; OR=2.913, P=0.008; OR=2.838, P<0.05。结论     前置胎盘患者有2次以上剖宫产史,超声发现胎盘陷窝、胎盘后低回声模糊或消失、膀胱子宫间隙血供增多者发生深层植入的风险增加,应有针对性地设计围术期多学科团队协作方案以改善临床结局。


Objective     To explore the clinical characteristics of placenta increta and percreta in patients with placenta previa to improve the clinical treatment and the patients’ outcomes. Methods     We retrospectively analyzed 571 patients with an ultrasound diagnosis of placenta previa at our center over a 4-year period. Univariate and logistic regression were used to explore the correlations between the clinical features of the patients and placental invasion, and the receiver operating (ROC) curve was used to assess the sensitivity and specificity of each clinical feature for the diagnosis of placenta increta and percreta. Results    For each increase in the number of cesarean sections, the risk of placenta increta and percreta increased by 3.433 times (OR=3.433, P=0.000). The risk of placenta increta and percreta was increased significantly in patients with placenta lacunae (OR=5.047, P=0.000), obscuration or disappearance of the retroplacental hypoechoic zone (OR=2.913, P=0.008), and hypervascular bladder-uterine interface (OR=2.838, P=0.005). Conclusion     The patients with placenta previa who have a history of 2 or more cesarean sections and ultrasound findings of placental lacunae, obscuration or disappearance of the retroplacental hypoechoic zone, and hypervascular bladder-uterine interface are at increased risks of placenta increta and percreta, and individualized perioperative care management involving multidisciplinary teams should be implemented for these patients to improve their outcomes.


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更新日期/Last Update: 2018-09-29