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目的:探讨胎盘植入病例的特点和治疗方法。方法:回顾性分析1999.03-2009.04收治11例胎盘植入病例资料。结果:3例早期妊娠胎盘植入均有剖宫产手术史,停经后有不规则阴道流血史;其中1例早期妊娠胎盘植入虽经超声提示孕囊位于子宫下段但仍误诊行人工流产及清宫手术时大出血;3例晚期妊娠分娩人工剥离胎盘时表明胎盘与子宫壁无间隙,经手术后病理证实胎盘植入;4例中期妊娠清宫时牵拉组织物有阻力,经彩色多普勒超声检查明确诊断;1例中期妊娠剖宫取胎时示胎盘与子宫壁无间隙,经手术后病理证实胎盘植入;3例早期妊娠者通过彩色多普勒超声检查确诊。早期处理的2例均手术切除子宫,近5年的9例行保守性手术和/或药物保守治疗成功保留患者生育功能。结论:对有剖宫产手术史患者停经后阴道流血就诊时,有必要行彩色多普勒超声检查;彩色多普勒超声检查有助于诊断胎盘植入;保守性手术和保守治疗可有效地避免子宫切除;严格剖宫产指征及重视避孕可预防胎盘植入的发生。
Objective: To investigate the characteristics and treatment of placenta accreta cases. Methods: Retrospective analysis of 11 cases of placenta accreta received 1999.03-2009.04. Results: 3 cases of placenta accreta in early pregnancy had history of cesarean section and irregular vaginal bleeding after menopause. One case of placenta accreta in early pregnancy showed that the gestational sac was located in the lower uterine segment by ultrasound but was misdiagnosed as abortion Bleeding in the operation of the Qing Dynasty; 3 cases of late pregnancy artificial delivery of the placenta during childbirth showed no gap between the placenta and the uterine wall, pathologically confirmed placenta accreta after implantation; 4 cases of mid-term pregnancy when pulling the Qing Palace have resistance, color Doppler ultrasound Check clear diagnosis; 1 case of cesarean section fetus during pregnancy showed no gap between the placenta and uterine wall, pathologically confirmed placenta accreta after surgery; 3 cases of early pregnancy confirmed by color Doppler ultrasound. In the early treatment of 2 cases, the uterus was surgically removed. In the recent 5 years, 9 cases underwent conservative surgery and / or conservative medical treatment to successfully preserve the patient’s reproductive function. CONCLUSIONS: Color Doppler sonography is necessary for treatment of post-menopause vaginal bleeding in patients with history of cesarean section; color Doppler ultrasonography is useful for the diagnosis of placenta accreta; conservative surgery and conservative treatment are effective Avoid hysterectomy; strict indication of cesarean section and emphasis on contraception can prevent the occurrence of placenta accreta.