凶险型前置胎盘合并胎盘植入的鉴别诊断及两种动脉球囊预置介入治疗比较

摘要

目的 探讨超声联合肌酸激酶(CK)检测在鉴别凶险型前置胎盘( PPP)合并胎盘植入与非植入中的价值及PPP合并胎盘植入的鉴别诊断及两种动脉球囊预置介入治疗对比分析.方法 PPP患者202例作为观察对象,经术中观察与病理诊断确诊其中101例为合并胎盘植入者,另101例为胎盘非植入者.所有患者均进行超声联合CK检测,对比诊断结果与确诊结果,分析该检测手段对PPP合并胎盘植入与非植入患者鉴别诊断的价值;对101例合并植入患者分别行腹主动脉球囊预置和双侧髂内动脉球囊预置两种介入疗法,并对比分析二者在PPP合并胎盘植入病例剖宫产手术中的应用价值.结果 PPP合并胎盘植入组孕妇血清CK值明显高于较非植入组,差异有统计学意义(P<0. 05);超声检测联合CK检测诊断凶险型前置胎盘合并胎盘植入时,当CK值达到105. 80时,诊断的准确度与敏感度均达到了100% ;当CK值为64. 80时,诊断未合并胎盘植入的准确度和敏感度分别为95. 05%和98. 60% ;腹主动脉球囊预置介入治疗与双侧髂内动脉预置球囊介入治疗后孕妇的术中出血量、子宫切除率、手术时间以及入住ICU时间比较差异均有统计学意义(P<0. 05),且腹主动脉球囊预置介入治疗组优于双侧髂内动脉预置球囊介入治疗组(P<0. 05).结论 超声联合CK检测对凶险型前置胎盘合并胎盘植入的鉴别诊断具有较好的临床价值,在PPP合并胎盘植入患者行剖宫产手术前,应用腹主动脉球囊预置止血技术优于双侧髂内动脉球囊预置止血效果,对于保证患者的治疗疗效具有重要意义.%Objective To explore the differential diagnosis of pernicious placenta previa ( PPP) combined with placenta accreta, and to analyze the efficacy of the two arterial balloon preset interventional therapies. Methods A total of 202 patients with PPP were divided into placenta accrete group (n=101) and non placenta accrete group (n=101) according to intraoperative observation and pathological diagnosis. All the patients underwent ultrasound combined with creatine kinase detection. The diagnosis results and confirmed results of the condition were compared to analyze the efficacy of the method in diagnosing. In addition, abdominal aortic balloon preset and bilateral internal iliac artery balloon preset were performed respectively on the patients of the two groups. Moreover, the application value of the two therapies in placenta previa combined with placenta accrete were compared and analyzed. Results The serum levels of CK in placenta accrete group were significantly higher than those in non placenta accrete group (P<0. 05). The diagnostic accuracy and sensitivity were 100% when the CK value was 105. 80 examined by ultrasonic detection combined with CK detection in diagnosis of placenta previa combined with placenta accrete. And the diagnostic accuracy and sensitivity were 95. 05% and 98. 60% ,respectively when the CK value was 64. 80 in diagnosis of PPP without placenta accrete. In addition, there were significant difference in blood loss, uterine resection rate, operation time and ICU stay time between abdominal aortic balloon preset treatment and bilateral internal iliac artery balloon preset intervention treatment (P<0. 05),moreover, abdominal aortic balloon preset treatment was superior to bilateral internal iliac artery balloon preset intervention treatment (P<0. 05). Conclusion Ultrasound combined with CK detection is very effective in differential diagnosis of pernicious placenta previa combined with placenta accrete. The clinical effects of abdominal aortic balloon preset treatment is superior to those of bilateral internal iliac artery balloon preset intervention treatment before cesarean section.