吕冲

[摘要] 目的 探究对植入型凶险性前置胎盘的临床诊断中磁共振的临床应用情况。 方法 回顾性分析2013年7月—2015年6月在该院接诊的凶险性前置胎盘患者60例，其中植入型凶险性前置胎盘患者25例，结合患者的手术和病理检查结果为参考标准，对植入型凶险性前置胎盘患者进行核磁共振以及彩色多普勒超声检查的联合应用评估，同时患者分别为粘连胎盘、植入性胎盘以及穿透性胎盘，结床分析。 结果 在胎盘植入的临床诊断中磁共振与磁共振和彩超联合诊断的临床诊断价值无合患者的病症分型对患者的磁共振图像进行临统计学差异（P>0.05），但结合患者的病理分型对磁共振的诊断准确率进行判定显示差异有统计学意义（P<0.05），在穿透性胎盘的诊断中其应用价值最高，而在粘连性胎盘的诊断中其应用价值则相对较低，数据显示差异有统计学意义（P<0.05）。 结论 在植入型凶险性前置胎盘的临床诊断中应用磁共振具有较高的诊断准确性，同时对患者的临床分型也有一定的应用，值得在临床上推广应用。

[关键词] 胎盘植入；前置胎盘；磁共振；临床分析

[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2016）02（b）-0169-03

[Abstract] Objective To discuss the clinical application situation of magnetic resonance in the clinical diagnosis of implantable dangerous placenta previa. Methods 60 cases of patients with dangerous placenta previa treated in our hospital from June 2013 to June 2015 were retrospectively analyzed， among them， 25 cases were implantable dangerous placenta previa and they were evaluated by the combined application of magnetic resonance and color Doppler ultrasonography according to the operative and pathological examination results and divided into the adherent placenta， implantable percreta and placenta percreta according to the clinical analysis. Results The difference in the clinical diagnostic value between the magnetic resonance diagnosis of placenta implantation and magnetic resonance combined with colour Doppler ultrasound diagnosis of placenta implantation was not statistically significant，（P>0.05）， the determination of diagnostic accuracy rate of magnetic resonance according to patients pathological type showed that the application value of magnetic resonance in the diagnosis of placenta percreta was highest， and was relatively low in the diagnosis of adherent placenta， the difference was obvious with statistically significance （P<0.05）. Conclusion The application of magnetic resonance in the clinical diagnosis of implantable？dangerous placenta previa has a higher diagnostic accuracy rate， at the same time， it has a certain effect on the patients clinical type， which is worth promotion and application in clinic.

[Key words] Placenta implantation； Placenta praevia； Magnetic resonance； Clinical analysis

凶险性前置胎盘是英国学者上世纪末提出来的，其基本定义是患者前次是进行剖宫产手术，其在该次妊娠中出现胎盘前置，同时其胎盘出现子宫瘢痕的覆盖，并且部分患者伴随有胎盘植入[1]。超过一般比率的凶险性前置胎盘会出现胎盘植入，因此在进行分娩过程中很容易出现产后大出血，对产妇和胎儿的生命安全都有很大威胁，是产科中较为危重的病症。在胎盘植入的临床诊断和治疗过程中需要结合其植入部位以及深度进行手术方案的制定，因此选择准确的诊断方法非常重要[2]。在产科检查中彩超是应用最为广泛的影像学技术，近年来随着磁共振扫描的发展和进步，有不少妊娠病症的检查结合了磁共振技术，并且在胎盘的检查中成逐渐为了不可替代的检查方案[3]。该研……