血HCG检测联合超声检查对凶险性前置胎盘植入类型的预测价值

Blood HCG detection combined with ultrasound examination of the predictive value of placenta previa implanted type

目的探讨血HCG检测值与凶险性前置胎盘植入类型的关系。方法回顾性分析2015年8月~2016年7月超声检查为凶险性前置胎盘8例患者的临床、检验及病理资料,评价血HCG检测值与凶险性前置胎盘植入类型的关系。胎盘植入类型分为:术中通过手术医生判断胎盘植入类型(a1组:部分性胎盘植入;a2组:完全性胎盘植入);术后通过病理医生判断胎盘植入的病理类型分为:(b1组:胎盘粘连型,胎盘绒毛附着于子宫肌层表面,没有侵入肌层;b2组:胎盘植入型,胎盘绒毛入侵子宫肌层深部,但未达到浆膜层;b3组:胎盘穿透型,胎盘绒毛入侵子宫肌层深部达子宫的浆膜层,或者穿透浆膜层,达到膀胱或直肠浆膜层甚至穿透肌层到黏膜层)。结果 a1组较a2组患者术前血β-HCG值低,术后血β-HCG恢复时间快,术中出血量少,子宫切除率低,b1,b2和b3 3组间比较,b3组术前血β-HCG值最高,术后血β-HCG恢复时间最慢,术中出血量最多,子宫切除率最高。结论凶险性前置胎盘并发胎盘植入者植入面积越大,深度越深,患者术前血β-HCG值越高,且术后血β-HCG恢复时间越慢。孕产期术中术后并发症越多。

Objective The relationship between detection value of blood HCG and placenta previa implanted type. Methods Retrospective analysis of August 2015 to July 2016 ultrasonography for 8 cases with placenta previa in clinical, laboratory and pathological data and evaluation of blood HCG value relationship with previa placenta implantation type. Placental implantation type: to judge the type of placenta implantation(a1 group: partial placenta implantation; a2 group: complete placenta implantation); By postoperative pathology doctors determine pathological types of placenta implantation can be divided into:(b1 group: placenta conglutination, placental villi attached to the surface of myometrium, no invading muscularis; b2 group: placenta implantation, placental villi myometrium invasion of deep, but fails to reach the serosal layer; b3 group: the placenta through type, deep placental villi myometrium invasion of uterine serosa layer, or through serous membrane layer, reach the bladder or rectum serous even through muscle layer to mucous membrane layer). Results a1 in patients with β-HCG than in the a2 group was lower than that before operation, recovery time of blood beta β-HCG was rapid after operation, the amount of bleeding during operation was low, and the hysterectomy rate was low, comparison between 3 groups of b1, b2 and b3, the β-HCG group had the highest blood beta β-HCG value before operation, the recovery time was the slowest, the bleeding volume was the highest, and the rate of hysterectomy was the highest in the b3 group. Conclusion Placenta previa complicated with placenta implantation were implanted area bigger, deeper, the higher β-HCG value was, the lower the recovery time of blood beta β-HCG was before operation. The more postoperative complications during pregnancy and puerperium.