胎盘植入剖宫产术中出血量与胎盘血管的MRI分析

MRI analysis between intraoperative amount of bleeding in placental implantation and the vascular signs

目的基于MRI成像,分析胎盘植入剖宫产术中出血量与植入处血管征象的关系。方法对109例患者剖宫产术前MRI表现进行分析,按手术结果分为术中出血常量组(≤500 mL)、中量组(>500~1000 mL)与大量组(>1000 mL)3组。观察胎盘植入类型(手术及病理证实),计算植入面积,计数植入处血管数目,测量血管最大管径。分析不同出血量之间的各种MRI表现是否存在差异并进行统计学检验,采用Spearman分析上述指标与术中出血量之间相关性。结果术中出血量300~4200 mL,常量组、中量组与大量组分别为42例、28例和39例,对比两名产科医师测量出血量进行一致性检验结果显示为0.92。3组植入面积和植入类型逐渐升高,差异均有统计学意义(P<0.01);在植入界面处血管征象方面,出血大量组的血管数目及管径明显高于其他2组(P<0.01),但常量组与中量组无显著性差异(P>0.01)。出血量与植入类型、植入面积、可视交界面血管数目、血管最大径存在正相关,相关系数依次为0.59、0.89、0.72、0.55。常量组血管数目少于2根(管径<2 mm);大量组血管数目大于5根(管径>2 mm);中量组血管数目介入两组之间(血管管径多≤2 mm)。结论剖宫产术中出血量与胎盘植入面积、植入深度及其交界面的血管征象存在密切关系。

Objective Based on MRI manifestations,aim of this study is to analyze the correlation between intraoperative blood loss and placental implantation,as well as vascular signs observed at the implantation site.Methods One hundred and nine patients with placenta implantation experienced cesarean delivery and preoperative MRI examinations,with subsequent analysis of the observed manifestations.The patients were then categorized into three groups:the intraoperative normal bleeding group(≤500 mL),the moderate bleeding group(>500 mL and≤1000 mL),and the large bleeding group(>1000 mL).Followed indexs were analyzed including the type of placental implantation(confirmed by surgery and pathology),quantifying the implantation area,enumerating the number of blood vessels at the implantation sites,and measuring the maximum diameter of the blood vessels.The differences in MRI manifestations were analyzed among different bleeding volumes and statistical tests were conducted.Results The intraoperative bleeding volumes ranged from 300 mL to 4200 mL,with a distribution of 42 cases in the normal group,followed by 28 cases in the medium group and 39 cases in the large group.The consistency of 2 obstetricians of bleeding amount was 0.92.The MRI area and type of implantation in the three groups increased gradually,with statistically significant differences(P<0.01).In terms of vascular signs at the implantation interface,large amount of bleeding group were significantly higher number and diameter of vessels compared to the other two groups(P<0.01).However,there was no significant difference between the normal amount of bleeding group and the medium amount of bleeding group(P>0.01).The amount of bleeding showed a positive correlation with the aforementioned MRI findings,including the type and area of implantation,the number and maximum diameter of abnormal vessels,with respective correlation coefficients of 0.59,0.89,0.72,and 0.55.The group with normal bleeding exhibited less than 2 vessels with a diameter of less than 2 mm,whereas the group with excessive bleeding demonstrated more than 5 vessels exceeding 2 mm in diameter.Conclusion There exists a significant correlation between the extent of hemorrhage and these MRI findings,encompassing the area and type of placental implantation,as well as vascular signs at the implantation interface.