凶险型前置胎盘合并胎盘植入的产前超声诊断分析

目的总结凶险型前置胎盘（PPP）合并胎盘植入产前超声声像图特征，分析PPP合并胎盘植入产前超声漏误诊原因。 方法应用经腹部联合经会阴部彩色多普勒超声对临床拟诊为PPP的51例孕妇行系统超声检查，与产后手术病理及临床随访结果对照分析。 结果51例PPP患者产前超声诊断完全性前置胎盘39例，不完全性前置胎盘12例，其中合并胎盘植入40例（78.4%，40/51），未合并胎盘植入7例（13.7%，7/51）。产后临床及手术病理检查证实51例PPP患者合并胎盘植入42例（82.4%，42/51），未合并胎盘植入9例（17.6%，9/51）；因超声图像不典型产前超声漏诊2例（3.9%，2/51），误诊2例（3.9%，2/51，将膀胱静脉曲张误认为血管横跨胎盘与膀胱间）。51例PPP患者经腹部超声检查显示胎盘增厚、弥漫性或局灶性胎盘实质内腔隙血流25例，胎盘后间隙消失、胎盘附着处子宫肌层变薄（≤2 mm）44例，子宫肌层弓状动脉排列紊乱34例，胎盘附着处子宫浆膜层-膀胱交界处血管丰富紊乱18例；经会阴部超声显示子宫下段膨隆、胎盘增厚25例，宫颈膨大、胎盘局部向宫颈内伸入6例，子宫下段及宫颈管胎盘覆盖处血流丰富8例。 结论孕妇凶险型前置胎盘有特征性超声表现，经腹部联合经会阴超声检查有助于正确诊断而减少误漏诊。

The prenatal ultrasonic diagnosis of pernicious placenta previa disease complex with placenta implantation

ObjectiveTo summarize the characteristics of pernicious placenta previa (PPP) disease complex with placenta implantation, and analyze the reason of ultraound misdiagnosis and missed diagnosis in placenta implantation proved by surgical pathology and clinically follow-up. MethodsFifty-one cases clinically diagnosed PPP disease patients were examined by both transabdominal and transperineal ultrasounography. ResultsOut of 51 PPP patients, 42 cases (82.4%, 42/51) were proved as placenta increta disease and 9 cases were confirmed with no placenta implantation complication. By transabdominal ultrasound (TAS) combined transperineal ultrasound (TPS) method: 40 cases were correctly diagnosed with placenta implantation (78.4%, 40/51), while 7 cases (13.3%, 7/51) were confirmed without placenta increta, 2 cases (3.9%, 2/51) were mis-diagnosed, 2 cases (3.9%, 2/51) were missed diagnosed. The goup of abdominal ultrasound findings: the placental thickening, diffuse or focal placenta essence lacuna in 25 cases, the gap disappeared after the placenta and placental uterine muscle layer becomes thin (less than or equal to 2 mm) 44 cases, uterine flesh layer arcuate artery arranged in disorder in 34 cases, placental uterine serosa layer bladder junction rich in blood vessels at 18 cases of disorder. Perineal sonography of performance: swelling of lower uterine segment lung, placenta thickening in 25 cases, cervical enlargement, placenta local to the cervical extends into the 6 cases, lower uterine segment and cervical tube placenta cover flow was rich in 8 cases. ConclusionsPPP disease complex with placenta implantation can be prenatally diagnosed by characteristic ultrasonic features. The combination of TAS and TPS can further improve the diagnostic accuracy of PPP.