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目的:总结妊娠晚期胎盘植入的危险因素、诊断和治疗经验,以期为胎盘植入的诊断和治疗提供临床指导。方法:回顾性分析2003年1月至2010年12月贵阳医学院附属医院117例妊娠晚期胎盘植入患者的危险因素、诊断和治疗方法。结果:住院分娩的12 267例产妇中,117例(9.54‰)诊断为胎盘植入。妊娠晚期胎盘植入危险因素为:前置胎盘、流产刮宫史≥2次、多产史、剖宫产史和年龄≥35岁(P<0.05)。诊断:病理诊断28例,临床诊断86例,B超诊断3例。治疗:保守治疗108例,子宫切除9例,无孕产妇死亡。子宫动脉栓塞有效例数6例(6/7),凝血酶纱条宫腔填塞有效例数6例(6/6),B超引导下胎盘局部注射甲氨蝶呤有效例数2例(2/2)。结论:(1)妊娠晚期胎盘植入与合并前置胎盘、流产刮宫史≥2次、多产史、剖宫产史和年龄≥35岁相关。(2)胎盘植入治疗以保守治疗为主,子宫动脉栓塞、凝血酶纱条宫腔填塞、B超引导下经腹胎盘局部注射甲氨蝶呤是胎盘植入保守手术治疗的有效方法。
Objective: To summarize the risk factors, diagnosis and treatment experience of placenta accreta in late pregnancy, in order to provide clinical guidance for the diagnosis and treatment of placenta accreta. Methods: The risk factors, diagnosis and treatment of 117 patients with placenta accreta in late pregnancy were retrospectively analyzed from January 2003 to December 2010 in Guiyang Medical College Affiliated Hospital. Results: Out of 12,267 mothers hospitalized, 117 (9.54%) were diagnosed as placenta accreta. Risk factors for placenta accreta in late pregnancy were placenta previa, history of abortion curettage ≥2, history of multiple births, history of cesarean section and age ≥35 years (P <0.05). Diagnosis: pathological diagnosis of 28 cases, 86 cases of clinical diagnosis, B ultrasound diagnosis in 3 cases. Treatment: Conservative treatment of 108 cases, hysterectomy in 9 cases, no maternal deaths. 6 cases (6/7) had effective uterine arterial embolization, 6 cases (6/6) effective thrombus gauze packing, 2 cases (2 cases) local injection of methotrexate /2). Conclusion: (1) Placenta accreta and placenta previa in the third trimester of pregnancy, the history of abortion curettage ≥ 2 times, history of multiple births, cesarean section history and age ≥35 years old. (2) The treatment of placenta accreta with conservative treatment, uterine artery embolism, thrombin thrombus gauze packing, B-guided transabdominal placental injection of methotrexate placenta accreta is an effective method of conservative surgery.