重型胎盘植入相关超声声像图特征的价值分析

Value analysis of ultrasonographic features in severe placental invasion

目的探讨两种不同类型重型胎盘植入(植入型和穿透型)的超声声像图特征,以提高产前超声诊断准确度,为临床处理提供可靠依据。方法纳入经临床或病理确诊的34例植入型(植入组)和34例穿透型(穿透组)胎盘植入患者,对其临床和超声检查结果进行回顾性分析,总结其超声声像图特征及差异。结果穿透组患者的平均分娩孕周较植入组早(P=0.040)。94.12%的患者既往有剖宫产史,剖宫产≥2次的18例患者中,14例为穿透型,两组对比差异有统计学意义(P=0.004)。两组胎盘位置、胎盘厚度比较差异无统计学意义(P=0.230、P=0.063)。穿透组胎盘后方子宫肌层均表现为局部中断或消失,两组间差异有统计学意义(P=0.001)。植入组以局限性小陷窝(44.12%)及广泛陷窝(50.00%)为主,而穿透组则以广泛陷窝(44.12%)及陷窝融合成片(47.06%)为主,两组间差异有统计学意义(P<0.001)。除穿透组2例患者出现膀胱线中断或消失外,其余患者均连续,两组间差异无统计学意义(P=0.493)。两组在宫颈血窦和宫颈形态方面差异有统计学意义(P<0.001、P=0.015)。73.53%和17.65%的植入型患者分别出现胎盘基底血流增多成团和跨界血管,而穿透型患者均出现跨界血管,两组间差异有统计学意义(P<0.001)。结论产前超声检查不仅可以诊断胎盘植入,而且可以评估胎盘植入的深度,能为全面而准确的临床决策提供重要信息。

Objective To evaluate the ultrasonographic features of severe placental invasion including placenta increta(PI),placenta percreta(PP),in order to increase prenatal diagnostic accuracy and provide reliable basis for clinical treatment.Methods 34 patients with PI(PI group)and 34 patients with PP(PP group)confirmed by clinical and pathological diagnosis were retrospectively enrolled.Clinical features,ultrasound findings were reviewed and compared between the two groups.Results Compared with the PI group,the gestational weeks at delivery in the PP group were significantly earlier(P=0.040).94.12%patients had a history of previous cesarean section.Among 18 cases with cesarean sections≥2 times,14 cases suffered from PP,the difference between the two groups was statistically significant(P=0.004).There were no significant differences in placental position and placental thickness between the two groups(P=0.230 and P=0.063,respectively).Retro placental myometrium was locally interrupted or disappeared in the PP group with significant differences between the two groups(P=0.001).Focal small placental lacunae(44.12%)and extensive lacunae(50.00%)were the main changes in the PI group,while the PP group was dominated by extensive lacunae(44.12%)and lacunae fusion(47.06%),there was significant difference between the two groups(P<0.001).Except for 2 cases in the PP group who had interruption or disappearance of bladder line,the others’bladder lines were normal,and there was no significant difference between the two groups(P=0.493).There were significant differences between the two groups in the abnormalities of cervical blood sinus and cervical morphology(P<0.001 and P=0.015).73.53%and 17.65%of PI patients had increased subplacental blood flow,forming a cluster and the emergence of cross-border blood vessels,respectively,while all patients with PP had cross-border blood vessels,the difference was statistically significant between the two groups(P<0.001).Conclusion Prenatal ultrasonography not only is an effective diagnostic tool for placental invasion,but also can assess the depth of placenta invasion,which can provide important information for comprehensive and precise clinical decision-making.