产后胎盘植入诊断中超声造影的临床应用研究

Clinical application of contrast-enhanced ultrasonography in the diagnosis of postpartum placenta accreta

目的研究产后胎盘植入诊断中超声造影的临床应用效果。方法随机选取2015年12月至2017年12月本院收治的疑似产后胎盘植入患者85例,具实施超声造影检查,详细观察病灶的边界、范围、位置以及造影剂灌注特点,与手术病理结果结合,分析超声造影检查的图像特征。结果表现为不均匀高增强的有71例,占83.53%;12例表现为低增强,占14.12%;2例表现为无增强,占2.35%。大多数的胎盘与周边邻近子宫肌层的界限较为清晰,边界平滑,但是也有少数部分边界凸凹不平,存在树枝状增强区。其中有2例造影剂注射之后,残留的胎盘病灶与周边的子宫肌层界限清晰,占2.35%,术后经过病理检查证实:诊断为胎盘粘连。80例在造影剂注射之后,残留的胎盘病灶与周边的子宫肌层界限不清晰,占94.12%,术后经过病理检查证实:诊断为胎盘植入。3例在残留胎盘附着处子宫浆膜层与肌层可见连续性的中断,注射造影剂之后,造影剂会外溢,术后经过病理检查证实:诊断为子宫破裂、胎盘穿透。结论产后胎盘植入患者采纳超声造影检查,可有效对植入胎盘中血流情况做出准确分析,对胎盘植入的程度以及范围进行良好评估,效果确切,值得借鉴。

Objective To study the clinical application of ultrasonography in the diagnosis of postpartum placenta accreta. Methods 85 suspect ed postpartum placenta accreta patients were randomly selected from December 2015 to December 2017. Contrastenhanced ultrasonography was performed. The boundary, range, location and perfusion characteristics of contrast media were observed in detail. Combined with the results of sur gery and pathology, the imaging features of contrastenhanced ultrasound were analyzed. Results There were 71 cases with uneven and high en hancement, accounting for 83.53%. 12 cases had low enhancement, accounting for 14.12%. 2 cases had no enhancement, accounting for 2.35%. The boundary between placenta and its adjacent myometrium is clear and smooth, but a few of them are rough and there are dendritic enhancement areas. The boundary between the residual placental lesion and the surrounding uterine myometrium was clear, accounting for 2.35%. The results of patho logical examination after operation confirmed that： after contrast medium injection, the boundary between the residual placental lesion and the sur rounding uterine myometrium was not clear. It was confirmed by pathological examination after operation： 3 cases of placenta accreta were diag nosed as interruption of the continuity of uterine serous layer and myometrium at the place where the placenta remained attached. After the treat ment, the contrast agent will overflow, the pathological examination after operation proves that the uterus is ruptured and the placenta penetrates. Conclusion The postpartum placenta accreta patients can make accurate analysis of the blood flow in the placenta accreta by using contrasten hanced ultrasound examination. The degree and scope of placenta accreta were evaluated well.