凶险型前置胎盘超声及磁共振影像特征

发布时间：2018-01-17 20:29

本文关键词：凶险型前置胎盘超声及磁共振影像特征　出处：《中华医学超声杂志(电子版)》2016年10期 　论文类型：期刊论文

【摘要】：目的探讨超声及磁共振成像在凶险型前置胎盘(PPP)诊断中的图像特征。方法对2014年1月至2015年1月孕20~24周在南京大学医学院附属鼓楼医院行产前超声及磁共振(MRI)检查(17例)疑诊为胎盘植入的27例患者进行连续超声随访检查至分娩,并与MRI及手术病理检查结果对照分析。结果 27例患者产前超声显示胎盘增厚14例;子宫肌层与胎盘基底部分界不清,胎盘后间隙部分消失17例;胎盘内见胎盘陷窝及丰富血窦15例;彩色多普勒示胎盘后或胎盘实质内有丰富的血流,血流紊乱湍急21例。27例患者超声表现:(1)植入型PPP 24例,声像图示子宫浆膜层连续,肌层部分回声失落,与胎盘基底部分界不清,胎盘后间隙部分消失;(2)穿透性植入3例,声像图示子宫浆膜层不连续,肌层回声失落,膀胱壁肌层回声不连续,胎盘基底部与膀胱壁分界不清,彩色多普勒示低阻高速动脉血流。27例中17例MRI检查,其中2例子宫结合带信号连续,子宫肌层变薄,10例子宫结合带信号中断,子宫肌层变薄受侵或信号不规则,血管迂曲扩张,流空血管影穿过肌层;5例胎盘绒毛侵入并穿透子宫肌层达浆膜层,子宫肌层信号完全消失,胎盘位于子宫轮廓线外,3例膀胱壁浆膜层信号中断,胎盘基底与膀胱交接连续性消失,膀胱壁上见胎盘结节。27例分娩结局:17例行髂内动脉临时球囊阻断+剖宫产术+次全子宫切除术;9例行髂内动脉临时球囊阻断+剖宫产术;1例行子宫动脉栓塞术+刮宫术治疗。因超声与MRI诊断及时,27例手术治疗后均未发生大出血等严重产科并发症。与超声、MRI及手术病理诊断结果对照,产前超声诊断植入型PPP并连续追踪随访至分娩的10例患者最终证实超声诊断正确7例,其余3例产后综合分析及病理检查均诊断为胎盘粘连;产前超声与MRI联合检查正确诊断PPP 13例(13/17),其余4例超声与MRI诊断结果不一致,其中2例超声诊断植入型PPP,MRI及病理诊断为胎盘粘连;2例MRI诊断PPP穿透性植入,超声及手术病理诊断植入型PPP。结论超声与MRI联合检查与产后病理诊断一致性好;PPP患者超声及MRI影像表现均有特征性,产前超声联合MRI检查互为补充和验证,可对PPP正确诊断及临床诊治提供重要的参考信息。
[Abstract]:Objective to investigate the application of ultrasonography and magnetic resonance imaging in the diagnosis of perilous placenta previa (PPP). Methods from January 2014 to January 2015, 17 cases were examined by prenatal ultrasonography and magnetic resonance imaging (MRI) at the Gulou Hospital affiliated to Medical College of Nanjing University. 27 patients suspected of placenta accreta were followed up by continuous ultrasound until delivery. The results were compared with the results of MRI and pathology. Results 14 cases of placenta thickening were detected by prenatal ultrasound in 27 cases. The boundary between the myometrium and the base of the placenta was not clear, and the part of the posterior placental space disappeared in 17 cases. Placental lacunae and abundant sinuses were found in 15 cases. Color Doppler imaging showed abundant blood flow after placenta or placenta parenchyma. Twenty-one patients (27 patients) with blood flow disorder were observed by ultrasound in 24 patients with implanted PPP. The sonographic images showed a continuous serous layer of the uterus. Some of the myometrium echo was lost, the boundary was not clear with the base of placenta, and the part of the posterior placental space disappeared. 2) penetrating implantation was performed in 3 cases. The sonographic images showed the uterine serous layer discontinuous, the myometrium lost, the bladder wall discontinuous, and the boundary between the base of placenta and the wall of bladder unclear. Color Doppler imaging showed that 17 out of 27 cases were examined by MRI, 2 cases of uterine conjunctival band signal was continuous, 10 cases of uterine myometrium thinning were interrupted by uterine conjunctival band signal. The uterine myometrium was thinned and invaded or the signal was irregular, the blood vessels were dilated, and the empty blood vessels passed through the myometrium. In 5 cases, the placental villi invaded and penetrated the myometrium to the serous layer, and the signal of the myometrium disappeared completely. The signal of the serous layer of the bladder wall was interrupted in 3 cases, and the continuity between the placental basement and the bladder disappeared. Placental nodule was seen on the wall of bladder. 17 cases with delivery outcome: 17 cases underwent subtotal hysterectomy by temporary balloon occlusion of internal iliac artery during cesarean section. 9 cases underwent caesarean section with temporary balloon occlusion of internal iliac artery. Uterine artery embolization was performed in 1 case. 27 cases were diagnosed by ultrasound and MRI without severe obstetric complications such as massive hemorrhage. Compared with the results of surgical and pathological diagnosis, 10 cases of implanted PPP diagnosed by prenatal ultrasound and followed up to delivery were confirmed to be correct by ultrasound in 7 cases. The other 3 cases were diagnosed as placental adhesions by postpartum comprehensive analysis and pathological examination. 13 cases of PPP were diagnosed correctly by prenatal ultrasound combined with MRI, and the other 4 cases were not consistent with MRI diagnosis. 2 cases were diagnosed with implanted PPP by ultrasound. Placenta adhesion was diagnosed by MRI and pathology. Two cases of MRI were diagnosed as penetrating implantation of PPP, ultrasound and operation and pathology were used to diagnose the implanted PPP.Conclusion Ultrasound combined with MRI is consistent with postpartum pathological diagnosis. Ultrasound and MRI findings of PPP patients are characteristic. Prenatal ultrasound combined with MRI examination is complementary and verified, which can provide important reference information for correct diagnosis and clinical diagnosis of PPP.
【作者单位】：江苏省南京市南京大学医学院附属鼓楼医院产前诊断中心;
【基金】：国家临床重点专科建设项目江苏省医学重点学科(XK201102) 江苏省科技发展计划项目(BL2012015 BE2009620) 江苏省卫生厅科技项目(H201340);江苏省卫生厅科技支撑计划-社会发展课题(BE2012606)
【分类号】：R445;R714.5
【正文快照】： 凶险型前置胎盘(pernicious placenta previa,PPP)是Chattopadhyay等[1]1993年首先提出,是指既往有剖宫产史,此次妊娠为前置胎盘,且胎盘附着于前次剖宫产切口瘢痕处的产科严重并发症,目前亦有研究者将前置胎盘合并植入称为植入型PPP[2]。PPP合并胎盘植入,产时和产后易发生难以

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