彩色多普勒超声在胎盘植入诊断与治疗中的应用价值

Application value of color Doppler ultrasound in diagnosis and treatment of placenta accreta

目的探讨胎盘植入的产前、产后及治疗中的声像图特征,提高彩色多普勒超声对胎盘植入的诊断和临床应用价值。方法回顾性分析我院经临床治疗和病理证实的胎盘植入患者40例,分析产前、产后胎盘植入及其治疗中的超声表现,比较产前、产后胎盘植入的检出率。结果 40例胎盘植入患者中,产前超声诊断11例,检出率为27.5%,声像图特征表现为胎盘内漩涡形成,胎盘后间隙消失及局部肌壁菲薄为主;彩色多普勒超声显示胎盘漩涡内血流丰富,胎盘基底血管丛增多。产后超声诊断25例,检出率为86.2%,声像图特征表现为局部肌壁菲薄,以胎盘与肌壁分界不清为主。临床予以化疗药物5-FU和MTX,再配合米非司酮保守治疗,治疗随访中见胎盘植入处肌壁明显增厚,胎盘基底血管血流减少为治疗有效。结论彩色多普勒超声能有效检出胎盘植入,具有重要的临床应用价值。

Objective To investigate the uhrasonographic characteristics of placenta accrete during prenatal, postnatal and the treatment process, and to improve the application value of color Doppler ultrasound in clinical diagnosis and treatment. Methods Forty patients with placenta accreta confirmed by clinical treatment and pathology were enrolled in this study. Their ultrasonic appearances of placenta accrete during prenatal, postnatal and the treatment process were analyzed, and their detection rate was compared. Results In 40 cases of placenta accrete, there were 11 cases confirmed by prenatal ultrasound, the detection rate was 27.5%. The appearances were： whirlpool in the placenta accreta, obliteration of retroplacental hypoechoic space and local thinning myometrium. Color Doppler ultrasound showed abundant blood flow signals in the placenta whirlpool, and increased placental basal blood branches. There were 25 cases confirmed by postnatal ultrasound, the detection rate was 86. 2%. Color Doppler ultrasound showed local thinning myometrium, and the dividing line between the placenta and uterine wall was indistinct. Chemotherapeutic drugs such as 5 - FU and MTX combined with cmifepristone were used as conservative treatmentin clinic. The follow up findings with obvious thicken myometrium at the placenta accreta and decreased placental basal blood branches were considered as effective treatment. The detection rate of postnatal sonographic diagnosis of placenta accreta was significantly higher than that of prenatal diagnosis. Conclusion Color Doppler ultrasound can significantly improve the detection rate of placenta accreta, which has important clinical application value.