目的 探讨术中B超引导在凶险型前置胎盘剖宫产手术过程中实时定位的应用价值.方法 选取2014年1月至2017年4月于南宁市第二人民医院产科经腹部超声诊断为凶险型前置胎盘的22例孕妇,采取剖宫产术中B超引导下选择子宫切口,观察胎儿娩出前后术中出血量和术后感染情况.结果 22例患者术中超声定位的胎盘位置与切开子宫后所见全部符合,有20例能有效避开胎盘,有2例需经胎盘打洞进入宫腔娩出胎儿.胎儿娩出前出血量均少于50 mL,胎儿娩出后术中出血量≤500 mL者6例(27.27％),500 mL<出血量≤1000 mL者11例(50.00％),出血量>1000 mL者5例(22.72％).术中发现胎盘植入3例,其中有2例出血超过4000 mL,术中切除部分宫壁组织,行子宫重建术.22例全部保留子宫,且术后未出现感染.结论 剖宫产术中B超引导可准确定位凶险型前置胎盘具体位置,指导手术切口的选择,可降低母体出血风险,应用安全,具有较好的临床价值.%Objective To explore the application value of intraoperative B -mode ultrasonography in real -time positioning during cesarean section of pernicious placenta previa .Methods Selected 22 pregnant women diagnosed as pernicious placenta previa by abdomen ultrasound in Nanning Second People's Hospital from January 2014 to April 2017.They were performed cesarean section under the guidance of B -mode ultrasonography . Observed the intraoperative blood loss before and after fetus delivery , and postoperative infection condition .Results The location of the placenta in the ultrasound localization of the 22 patients were consistent with that seen after the incision of the uterus .There were 20 cases can effectively avoid the placenta , 2 cases needed to go through the placenta into the uterus to deliver the fetus .The amount of bleeding before delivery of the fetus were less than 50 mL, intraoperative blood loss after delivery of the fetus ≤500 mL in 6 cases(27.27％);500 mL1000 mL in 5 cases(22.72％).Placenta accreta found in 3 cases, of which 2 cases of bleeding more than 4000mL, with intraoperative resection of part of the uterine wall tissue and uterine reconstruction .22 cases all retained the uterus ,with no infection after surgery .Conclusion In the cesarean section , the B-ultrasound guidance can accurately locate the specific position of the pre -placenta , and guide the choice of surgical incision , which can reduce the risk of maternal bleeding and have safe application and good clinical value .
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