目的 探讨产前联合应用二维及彩色多普勒超声对不同深度胎盘植入的诊断及临床应用价值.方法 方对我院产前超声检查怀疑有胎盘植入的38例孕妇超声、临床、手术及病理随访,胎盘植入诊断以手术与病理结合为标准.结果 最终36例孕妇确诊为胎盘植入,其中胎盘粘连19例,胎盘植入11例,胎盘穿透6例,均合并前置胎盘.产前超声对胎盘植入或穿透诊断准确率高,而胎盘粘连诊断准确率相对较低.不同深度胎盘植入二维表现均以子宫肌层菲薄、胎盘多发腔隙为多见,CDFI显示胎盘后方血流信号丰富,当血流信号到达子宫浆膜层,并向膀胱外溢时有可能穿透.胎盘粘连多可采用保守治疗,胎盘植入可结合子宫动脉栓塞治疗,胎盘穿透最凶险,临床多需子宫切除.结论 产前联合应用二维及彩色多普勒超声综合评判,可为临床诊治胎盘植入或胎盘穿透提供客观依据.%Objective To explore the combined use of two dimensional and color Doppler ultrasound in the diagnosis of differ -ent depth of prenatal placenta implantation and its application value in clinic .Methods 38 cases of pregnant women with sus-pected placenta implantation underwent prenatal ultrasound as well as the clinical , surgical, and pathological follow-up.The final diagnosis of placenta implantation is based on the combined tests of surgery and pathology .Results Finally, 36 cases of pregnant women were diagnosed as placenta implantation .Of those, 19 cases were placental adhesion , 11 cases were implanted placenta , 6 cases were penetrative placenta .All cases were complicated with placenta previa .The accuracy of prenatal ultrasound in the diag-nosis of placenta implantation and penetration was high , whereas , the rate for the diagnosis of placental adhesion was relatively low.The more common manifestations of different depth of prenatal placenta implantation on two -dimension ultrasound were the thinning myometrium and multiple lacuna of placenta .CDFI showed that blood flow signal was rich in the rear placenta .When the blood flow signal reached the serous membrane , it was possible to penetrate into the bladder .Conservative treatment can be used in the treatment of placenta adhesion and placenta implantation can be treated in combination with uterine artery embolization . Placenta percreta was the most dangerous , which,in most case, needs hysterectomy in clinic .Conclusion Combined application of two dimensional and color Doppler ultrasound can provide an objective basis for clinical diagnosis and treatment of placenta or placenta penetration .
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