摘要
目的探讨超声评分系统预测胎盘植入类型及凶险程度的价值。方法回顾性分析2005年1月至2014年11月在北京大学第三医院分娩的180例胎盘植入患者的临床资料。分析分娩前超声影像学特点，按照胎盘位置及厚度、胎盘后低回声带是否消失、膀胱线是否连续、胎盘陷窝性状、胎盘基底部血流信号、宫颈形态是否完整、宫颈是否存在血窦，以及剖宫产史等项目，每项评0-2分，计算总分值。计算不同类型胎盘植入患者超声评分量表的临界值，并比较各类型患者术中出血量及子宫切除率。采用方差分析、秩和检验或X^2检验进行统计学分析，并绘制受试者工作特性曲线，计算不同类型患者超声评分的界值。结果180例中，粘连型115例，植入型38例，穿透型27例。将后2种类型合称为重型胎盘植入。粘连型患者的出血量低于重型患者[M（min-max），分别为200（100-4000）与3025（100-15000）ml，P〈0．01]，在重型患者中，植入型与穿透型术中出血量差异无统计学意义（P=0．350）。粘连型患者均未切除子宫。粘连型与重型子宫切除牢相比，差异有统计学意义[0例与29．2％（19／65），P〈0．01]。其中植入型患者18．4％（7／38）切除子宫，低于穿透型的44．4％（12／27），差异有统计学意义（P〈0．01）。粘连型患者的超声评分低于重型患者[（1.88±1．45）与（7．01±2．15）分，P〈0．01]。重型患者中，植入型的评分又低于穿透型[（6．08±2．62）与（8．74±2．75）分，P〈0．01]。受试者工作特性曲线显示，当曲线下面积为94．3％、评分≥4．5时，敏感度为81．5％，特异度为95．7％，确定粘连型和重型的界值为5分；当曲线下面积为91．1％、评分≥2．5时，敏感度为92．1％，特异度为75．7％，故粘连型和植入型的界值为3分；当曲线下面积为74．6％、评分≥9．5分时，敏感度为
Objective To explore the value of ultrasound scoring system in predicting the type and risk of placenta accreta. Methods Clinical data of 180 placenta accreta patients who delivered in the Peking University Third Hospital between January 2005 and November 2014, were retrospectively analyzed. Prenatal ultrasonographic features were analyzed, including position and thickness of the placenta, disappearance of hypo- echoes in posterior placenta, continuousness of ＂bladder line＂, existence of lacuna, condition of the subplacental vascularity, completeness of cervical morphology, existence of cervical sinus, and history of cesarean section. A score of 0, 1 or 2 was given to each item, and a sum-up was calculated for each patient. The cut-off scores of patients with placenta accreta, placenta increta and placenta percreta were calculated by receiver operating characteristic carve, respectively. At the same time, blood loss and hysterectomy rate were compared among the three groups. Variance analysis, rank sum or Chi-square tests were used for statistical analysis. ResultsAmong the 180 cases, there were 115 cases of placenta accreta, 38 of planceta increta and 27 of placenta percreta. Placenta increta and percreta were defined as the severe type. Blood loss in placenta accreta was lower than in the severe type [200 （100-4 000） ml vs 3 025 （100-15 000） ml, P〈0.01]. There was no difference in blood loss between patients with placenta increta or percreta （P=0.350）. No hysterectomy was performed for patients with placenta accreta, the rate being lower than in the severe type [0 vs 29.2% （19/65）, P〈0.01]. Among the severe type, 18.4% （7/38） of the placenta increta patients underwent hysterectomy, the rate being lower than in placenta percreta patients [44.4% （12/27）, P〈0.01]. The score in placenta accreta was lower than in the severe type [（1.88±1.45） vs （7.01 ±2.15） scores, P〈0.01]. In the severe type, the score in placenta increta was lower than in placenta percreta [（6.08 ±
出处
《中华围产医学杂志》
CAS
CSCD
2016年第9期705-709,共5页
Chinese Journal of Perinatal Medicine
关键词
侵入性胎盘
超声检查
产前
疾病严重程度指数
失血
手术
预测
Placenta accreta
Ultrasonography, prenatal
Severity of illness index
Blood loss, surgical
Forecasting
