84例胎盘植入患者的治疗与结局

目的分析不同类型胎盘植入患者的合理治疗方法选择。 方法回顾性分析中山大学附属第一医院妇产科2000年1月1日至2009年6月30日治疗的84例胎盘植入病历资料，根据分娩时胎盘是否完全清除分为根治性治疗组(54例)和保守性治疗组(30例)。两组病例一般资料的比较、子宫体部胎盘植入和前置胎盘植入子宫切除率的比较采用卡方检验，出血量组间差异比较采用秩和检验。 结果84例胎盘植入中，根治性治疗54例(64%)，其中子宫切除9例(17%)，产后出血25例(46%)。保守性治疗30例(36%)，其中4例(13%)治疗失败切除子宫，产后出血14例(47%)，晚期产后出血4例(13%)，产褥感染1例(3%)；保留子宫的26例中，14例(54%)残留胎盘需后续手术清除。前置胎盘并胎盘植入保守治疗失败率高，出血量大，子宫切除率(36.36%)，显著高于宫体部胎盘植入的子宫切除率(1.96%)，χ²＝16.409，P<0.05。 结论产后出血是胎盘植入的常见并发症，治疗方案的选择应以控制子宫出血为前提，治疗的难点是前置胎盘植入和穿透性植入者，前置胎盘植入根治性治疗优于保守治疗，植入范围>10 cm且穿透性植入的前置胎盘宜切除子宫。

Therapeutic options and pregnancy outcomes of placenta accreta: a report of 84 cases

ObjectiveTo evaluate the complications and outcomes of placenta accreta with different treatments. MethodsClinical data of 84 cases of placenta accreta from Jan. 2000 to Jun. 2009 were analyzed retrospectively.All cases were divided into radical treatment group and conservative treatment group in accordance with complete placenta removal or not. General clinical data and hysterectomy ratios were evaluated using chi-square test. The amount of bleeding was evaluated using Kruskal-Wallis test. ResultsA total of 54 cases were in radical treatment group (64%)with 9 cases of obstetrical hysterectomy(17%)and 25 cases of(46%)postpartum hemorrhage. Thirty cases were in conservative treatment group (36%)with 4 cases of obstetrical hysterectomy(13%), 14 cases of postpartum hemorrhage(47%), 4 cases of late postpartum hemorrhage(13%) and 1 cases of puerperal infection(3%). In 26 uterus-preserved cases, 14 cases(54%) needed reoperation for placenta remnants removal. Obstetric hysterectomy rate in placenta previa with placenta accreta was 36.36% and was higher than that of placenta accreta in corpus uteri significantly 1.96%, (χ²=16.409, P<0.05). And there was higher failure rate and more blood loss of conservative treatment than radical treatment in placenta previa with placenta accreta. ConclusionsPostpartum hemorrhage is the common complication of placenta accreta. Controlling bleeding is the premise of therapeutic options and the difficult issues are placenta accreta in placenta previa and placenta percreta. For placenta previa with placenta accreta cases, radical treatment is better than conservative treatment. For placenta previa with placenta percreta and placenta implants >10 cm case, hysterectomy is appropriate.