前置血管的产前超声检查影像特征

Prenatal Ultrasonic Imaging Characteristics of Vasa Previa

【目的】探讨前置血管的产前超声检查影像学特征。【方法】收集经手术和病理检查确诊的前置血管患者53例，均行产前超声检查，分析53例患者的产前超声影像特征。【结果】产前超声诊断前置血管诊断准确率为83％（44／53），漏诊率15％（8／53），误诊率2％（1／53）。产前超声下前置血管分两型：Ⅰ型（单叶胎盘型）49例，仅见一个胎盘，该型又分成三个亚型，包括①Ⅰa型（完全性帆状胎盘型）27例（脐带插入点位于胎膜上，脐血管的分支均沿胎膜走行）；②Ⅰb检查（部分性帆状胎盘型）21例（脐带插入胎盘表面前发出多个分支，部分分支进入胎盘实质，部分分支走行于胎膜之上）；③Ⅰc检查（球拍胎盘型）1例（脐带插入点位于距胎盘边缘≤2 cm的胎盘实质内）；Ⅱ型多叶胎盘型4例（此型前置血管可伴发两叶胎盘或多叶胎盘或副胎盘）。【结论】产前超声检查简便、无创，是诊断前置血管的首选方法。

[Objective] To explore the prenatal ultrasonic imaging findings of vasa previa .[Methods] A total of 53 patients with vasa previa were recruited from 2011～2014 at our hospital .All cases were confirmed by operation and pathological examination .And their prenatal ultrasonic imaging characteristics were summa‐rized .[Results] Among them ,the diagnosis of vasa previa was definite （ n = 44 ,83% ） ,missed （ n = 8 , 15% ） and misdiagnosed （ n =1 ,2% ） .They were divided into two types by prenatal ultrasound ：⑴ typeⅠ（simple placenta ,n=49） including Ⅰa completeness placenta velamentosa （ n=27） ,Ⅰb partial placenta vel‐amentosa （ n=21） andⅠc battledore placenta （ n=1） .①The umbilical cord insertion point of Ⅰa type was on membranes and all branches of umbilical cord passed along membranes .② Umbilical cord ofⅠb grew bran‐ches before inserting into placental surface .Some umbilical cord branches ofⅠb run into placenta parenchyma and membranes .③The umbilical cord insertion point of Ⅰc was located in placenta parenchyma from placental edge 2 cm or less ;⑵ TypeⅡ （placenta multiplex ,n =4） .It was complicated by bilobed placenta ,placenta multiplex or accessory placenta .[Conclusion]Prenatal ultrasound is a preferred noninvasive diagnostic modali‐ty for vasa previa .