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目的:总结凶险型前置胎盘危险因素,产前诊断及治疗经验,为此类疾病的规范化治疗提供帮助。方法:分析总结2012年1月至2014年底收治的凶险型前置胎盘病人共105例的临床病例资料。对于产前诊断,胎盘附着部位,剖宫产次数,手术治疗的方法措施进行分析。结果:⑴分娩前彩超检查帮助胎盘植入的诊断,并且容易普及,经济方便;如果病情允许病人接受情况下可以联合MRI检查可以大大提高诊断率。⑵术中选择胎盘边缘切口,卡前列素氨丁三醇注射液,宫腔填纱术,局部8字缝合术,Cho缝合及B-lynch缝合术,子宫动脉结扎术等办法有效地减少术中出血,降低子宫切除比例。⑶剖宫产次数的增加及胎盘附着部位不同均是影响病人预后如术中出血量,子宫切除率等的重要因素。结论:术前综合评估病人病情及初步判断有无胎盘植入有助于术前准备及手术方式的选择,配合药物及多种手术方式已能够有效降低病人产后出血等并发症的发生率。
OBJECTIVE: To summarize the risk factors of plague-induced placenta previa, prenatal diagnosis and treatment experience, and to provide help for the standardization of such diseases. Methods: The clinical data of 105 patients with malignant placenta previa collected from January 2012 to the end of 2014 were analyzed and summarized. For prenatal diagnosis, placental attachment site, the number of cesarean section, surgical treatment methods and methods for analysis. Results: (1) Pre-delivery color Doppler ultrasound examination to help diagnose placenta accreta and easy to popularize, economic convenience; if the condition allows the patient to accept the case can be combined with MRI examination can greatly improve the diagnostic rate. ⑵ intraoperative choice of placental margin incision, cardoprost tromethamine injection, intrauterine filling, local 8-suture, Cho suture and B-Lynch suture, uterine artery ligation and other methods to effectively reduce the operation Bleeding, reducing the proportion of hysterectomy. ⑶ increase in the number of cesarean section and placenta accreta different positions are affecting the prognosis of patients such as intraoperative blood loss, hysterectomy rate and other important factors. Conclusion: The preoperative comprehensive assessment of the patient’s condition and the preliminary assessment of the placenta accreta contribute to the choice of preoperative preparation and surgical methods. Combined with drugs and various surgical procedures, the incidence of complications such as postpartum hemorrhage can be effectively reduced.