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目的:探讨凶险型前置胎盘临床分级诊断方法,为临床处理提供指导。方法:选取2011年1月~2013年12月在该院分娩的凶险型前置胎盘孕妇146例,根据术中所见并结合术后组织病理学检查进行临床分级,其中Ⅰ级58例、Ⅱ级48例、Ⅲ级19例和Ⅳ级21例,分别设为Ⅰ组、Ⅱ组、Ⅲ组和Ⅳ组。比较各组间出血量、输血量及术中止血措施使用情况的差异性。结果:1Ⅱ组出血量及输血量均比Ⅰ组增多(P<0.05),Ⅲ组出血量及输血量均比Ⅱ组增多(P<0.05),Ⅳ组出血量及输血量均比Ⅲ组增多(P<0.05);2Ⅰ组使用一般止血措施多于Ⅱ组(P<0.05);Ⅱ组采用保守性手术多于Ⅰ组和Ⅲ组(P<0.05);Ⅲ组子宫切除率高于Ⅱ组(P<0.05),Ⅳ组子宫切除率高于Ⅲ组(P<0.05)。Ⅰ组和Ⅱ组患者无泌尿系统损伤,Ⅲ组有2例损伤,Ⅳ组有10例损伤。结论:凶险型前置胎盘临床分级越高凶险程度越高;建议规范术前影像学检查,对凶险型前置胎盘进行临床分级诊断,指导临床处理。
Objective: To investigate the clinical classification of dangerous placenta previa and provide guidance for clinical treatment. Methods: A total of 146 pregnant women with dangerous placenta previa were enrolled in our hospital from January 2011 to December 2013. According to the findings of surgery and postoperative histopathological examination, we classified 58 cases of grade Ⅰ, Ⅱ 48 cases in grade, 19 cases in grade Ⅲ and 21 cases in grade Ⅳ, which were divided into group Ⅰ, group Ⅱ, group Ⅲ and group Ⅳ. The differences of bleeding, blood transfusion and intraoperative hemostasis were compared between groups. Results: The amount of blood transfusion and blood transfusion in group Ⅱ increased more than that in group Ⅰ (P <0.05), and the amount of blood transfusion and blood transfusion in group Ⅲ increased more than that of group Ⅱ (P <0.05) (P <0.05). There were more general hemostatic measures in group ⅡⅠ than those in group Ⅱ (P0.05). The conservative surgery in group Ⅱ was more than that in group Ⅰ and Ⅲ (P <0.05). The rate of hysterectomy in group Ⅲ was higher than that in group Ⅱ (P <0.05). The hysterectomy rate in group Ⅳ was higher than that in group Ⅲ (P <0.05). Patients in group Ⅰ and group Ⅱ had no urinary tract injury, group Ⅲ had 2 cases of injury, and group Ⅳ had 10 cases of injury. Conclusions: The clinical grade of aggressive placenta previa is higher and the risk is higher. Preoperative imaging examination is recommended, and clinical diagnosis of dangerous placenta previa is conducted to guide the clinical treatment.