凶险型前置胎盘并发穿透性胎盘植入3例分析及文献复习

摘要

目的 探讨凶险型前置胎盘并发穿透性胎盘植入的治疗及手术方法,提高母儿救治水平.方法 回顾性分析我院近2年收治的凶险型前置胎盘并发穿透性胎盘植入的3例患者的临床资料.结果 近2年在我院住院分娩孕妇共5002例,凶险型前置胎盘并发穿透性胎盘植入3例,其中1例有1次剖宫产史,1次流产史;1例有2次剖宫产史,2次流产史;1例有1次顺产史,1次剖宫产史,1次流产史.其中1例术中诊断,2例术前彩超检查诊断,3例术后病理确诊胎盘植入.3例终止妊娠的孕周分别为34+5、32+5、34+5周;1例行子宫下段横切口剖宫产术+全子宫切除术,1例行子宫体部纵切口剖宫产术+次全子宫切除术,1例行子宫中段剖宫产术+腹主动脉压迫+子宫动脉结扎术.结论 凶险型前置胎盘终止妊娠的孕周可提前至32 ～34周;术前应充分准备,并制定手术预案;在胎盘娩出前可行腹主动脉压迫及子宫动脉结扎减少出血量,保留子宫.%Objective To investigate the treatment and surgical appoach of pernicious placenta previa complicated with placenta percreta so as to enhance the prognosis of the pregnancy women and their babies.Methods The clinical datas were reviewed and analyzed of three women with pernicious placenta previa complicated with placenta percreta in our hospital in the past two years.Results A total of 5002 pregnancy women were admitted to deliver in our hospital in past two years.Three cases were suspected with placenta percreta.One of them had history of cesarean section and abortion once respectively ; Another one had history of cesarean section and abortion twice respectively ; The third one had history of spontaneous delivery,cesarean section and abortion once respectively.With B-ultrasound,two of them were suspected with placenta percreta,all of them were in the diagnosis of postoperative pathologic diagnosis.The gestational age of the 3 patients were 34 +5,32 +5,34 +5 weeks respectively.One case had cesarean section and complete hysterectomy,one case had cesarean section and supracervical hysterectomy,one case had cesarean section,abdominal aorta compression and ligation of uterine artery.Conclusions Time of pregnancy termination can be advanced to 32-34 weeks for the women with pernicious placenta previa.If the placenta percreta is suspected at the scar of previous cesarean section,sufficient preparation and surgical plans are needed preoperatively; Abdominal aorta compression and ligation of uterine artery are needed before placenta expulsion.