2020 年第 7 期 第 15 卷

妊娠早期超声检查对瘢痕子宫胎盘植入的临床诊断价值

Diagnostic value of ultrasonography in placenta accreta of cesarean scar uterus in early pregnancy 

作者：秦波1李媛媛1徐韦1黄欢2

英文作者：Qin Bo1 Li Yuanyuan1 Xu Wei1 Huang Huan2

单位：1东南大学附属中大医院江北院区南京市大厂医院超声诊断科，南京210044；2南京医科大学附属南京医院妇产科211100

英文单位：1Department of Ultrasound Diagnosis Jiangbei Hospital District Zhongda Hospital Southeast University Dachang Hospital of Nanjing Nanjing 210044 China； 2Department of Obstetrics and Gynecology Nanjing First Hospital Nanjing Medical University Nanjing 211100 China 

关键词：瘢痕子宫；超声；胎盘植入；妊娠早期

英文关键词：Scaruterus；Ultrasound；Placentaimplantation；Earlypregnancy

• 摘要：

• 目的探讨妊娠早期超声检查对瘢痕子宫胎盘植入的临床诊断价值。方法选择2015年10月至2018年3月于东南大学附属中大医院产科规律产检并经超声诊断为胎盘植入患者42例（观察组），另选择同期产检超声检查提示胎盘附着于子宫前壁且覆盖宫颈内口但未发现胎盘植入患者56例（对照组），分析2组的手术病理检查结果及超声声像图特征、妊娠早期胎盘植入的超声表现、妊娠结局以及妊娠早期超声检查对剖宫产瘢痕子宫胎盘植入的临床诊断价值。结果观察组42例患者最终手术及病理明确诊断为胎盘植入者39例，3例被超声误诊为胎盘植入；对照组56例中4例超声检查漏诊胎盘植入，其余52例超声诊断正确。观察组42例患者超声声像中胎盘后方低回声区异常、胎盘后方子宫肌层变薄、胎盘实质内腔隙血流及子宫浆膜-膀胱交界处血流信号丰富比例显著高于对照组（均P<0.05）。观察组39例胎盘植入者中10例接受经腹子宫全切或次全切除术治疗，20例接受剖宫产取胚，6例进行引产，2例孕18周发生子宫破裂，胎儿死亡，1例在孕23周无明显诱因胎死宫内。对照组4例漏诊胎盘植入者中1例接受子宫次全切除术，3例剖宫产取胚。观察组3例和对照组52例正常妊娠并正常分娩者，新生儿结局良好，均为单胎，未出现不良事件。妊娠早期超声检查诊断剖宫产瘢痕子宫胎盘植入的敏感度为90.7%（39/43），特异度为94.5%（52/55），约登指数为85.2%。结论妊娠早期超声检查对剖宫产瘢痕子宫胎盘植入诊断的敏感度和特异度较高，有助于及时采取正确的临床处理措施，避免不良结局的发生。

• ObjectiveTo explore the value of ultrasonography in the diagnosis of cesarean scar placenta implantation. Methods From October 2015 to March 2018, 42 patients (observation group) with placenta implantation diagnosed by ultrasound admitted to Jiangbei Hospital District, Zhongda Hospital, Southeast University were selected. Fifty-six patients  with placenta accreted to the anterior wall of the uterus without placenta implantation were selected as control group. The value of ultrasonography in the diagnosis of cesarean scar placental implantation were analyzed. Results  In the observation group, 39 cases were diagnosed of placental implantation by final operation and pathology； 3 cases were misdiagnosed of placental implantation by ultrasound； in the control group, 4 cases had missed placental implantation and the other 52 cases were diagnosed correctly by ultrasound. In the observation group, the proportion of patients with abnormal hypoechoic area behind the placenta, thinning of the myometrium behind the placenta, blood flow in the parenchyma of the placenta, and abundant blood flow signals at the serous-bladder junction of the placenta was significantly higher than that of the control (P<0.05). In the observation group, 10 of 39 placental implants were treated by total or subtotal abdominal hysterectomy, 20 cases by cesarean section, 6 cases by induction, 2 cases by rupture of uterus at 18 weeks of gestation and 1 cases by 23 weeks of gestation. In the control group, 1 case received subtotal hysterectomy and 3 cases received cesarean section. Atotal of 55 cases of normal pregnancy and normal delivery had good neonatal outcomes. The sensitivity, specificity and accuracy of ultrasonography in early pregnancy were 90.7%(39/43), 94.5%(52/55) and 85.2% respectively. Conclusion The sensitivity and specificity of ultrasonography in early pregnancy for the diagnosis of cesarean scar placenta implantation is high.