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随着孕妇妊娠年龄的增加,以及剖宫产后再次妊娠数量的增加,凶险型前置胎盘合并胎盘植入已经成为相对常见的严重并发症之一。其中临床处理最困难的情况往往是前置胎盘合并胎盘植入并穿透子宫浆膜层侵及膀胱后壁,一般称为“穿透入膀胱的凶险型前置胎盘”。文章基于近期相关病例报道和综述性文献的收集,就穿透入膀胱的凶险型前置胎盘的孕期处理、术前诊断、围手术期的准备以及不同手术方式的介绍、保守性治疗方案等关键问题进行了阐述,提出目前该种病例的诊治尚没有统一的临床指南或规范,往往强调个体化的诊治思路。即以保证孕妇生命安全和生活质量为底线,兼顾胎儿生存,减少术中出血,最大可能保护再生育能力为原则。诊治工作重在预防和早期识别,充分的产前评估及术前准备以及正确的手术策略选择是诊治成功与否的关键。
With the increase of gestational age of pregnant women and the increase of the number of pregnancies after cesarean section, the plague of placenta previa together with placenta accreta has become one of the more common serious complications. One of the most difficult cases of clinical treatment is often placenta previa and placenta accreta penetrating the uterine serosa and invasion of the posterior wall of the bladder, commonly known as “penetrating into the bladder of the risk of placenta previa ”. Based on the recent reports of relevant cases and collection of review articles, the article deals with the key aspects of prenatal diagnosis, perioperative preparation, presentation of different surgical modalities, and conservative treatment plans for the treatment of precarious placenta previa that penetrate into the bladder The problem is elaborated, and at present, there is no unified clinical guideline or norms for the diagnosis and treatment of this kind of cases, and individualized diagnosis and treatment ideas are often emphasized. That is to ensure the safety and quality of life of pregnant women as the bottom line, taking into account fetal survival, reduce intraoperative bleeding, the greatest possible protection of reproductive capacity for the principle. Diagnosis and treatment focused on prevention and early identification, adequate prenatal assessment and preoperative preparation and the correct choice of surgical strategy is the key to the success of diagnosis and treatment.