本文選題：剖宮產(chǎn)瘢痕妊娠 + 胎盤植入��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：第一部分探討超聲診斷剖宮產(chǎn)瘢痕妊娠與胎盤植植入關(guān)系目的:本研究的目的是探討超聲診斷剖宮產(chǎn)瘢痕妊娠與胎盤植入的關(guān)系,為瘢痕妊娠的自然發(fā)展提供更多循證學(xué)依據(jù),并且針對瘢痕妊娠病人進(jìn)行分型,了解不同類型的剖宮產(chǎn)瘢痕妊娠病人的臨床結(jié)局。資料和方法回顧性收集2014年1月至2017年2月于山東大學(xué)齊魯醫(yī)院超聲診斷為剖宮產(chǎn)瘢痕妊娠并選擇繼續(xù)妊娠管理的病人19例。獲取其診斷剖宮產(chǎn)瘢痕妊娠及隨后不同孕周的超聲圖像、臨床資料、病理資料。將獲取的瘢痕妊娠超聲圖像進(jìn)行分組(即低風(fēng)險(xiǎn)組與高風(fēng)險(xiǎn)組),比較兩組妊娠結(jié)局,探究剖宮產(chǎn)瘢痕妊娠與胎盤植入的關(guān)系。結(jié)果:19例病人中,16(16/19)例在隨后孕周超聲檢查提示胎盤植入,18(18/19)例臨床/病理診斷為胎盤植入,超聲診斷胎盤植入敏感性為88.99%,陽性預(yù)測價(jià)值100%。4例胎盤穿透病人均在早孕期(12周,12周,9周+6天,10周)超聲檢查就提示胎盤植入。將瘢痕妊娠病人分為低風(fēng)險(xiǎn)組10例,高風(fēng)險(xiǎn)組9例,比較兩組的臨床結(jié)局:術(shù)中出血低風(fēng)險(xiǎn)組1100ml低于高風(fēng)險(xiǎn)組2000ml,P=0.269;活產(chǎn)兒低風(fēng)險(xiǎn)組中有9例(9/10)高于高風(fēng)險(xiǎn)組中4例(4/9),P=0.057;子宮切除低風(fēng)險(xiǎn)組1例(1/10),高風(fēng)險(xiǎn)組1例(1/9),P=1.000;胎盤穿透4(4/9)例均出現(xiàn)在高風(fēng)險(xiǎn)組,p=0.033。結(jié)論:剖宮產(chǎn)瘢痕妊娠與胎盤植入關(guān)系密切,瘢痕妊娠可能是胎盤植入的前期表現(xiàn)形式。胎盤穿透的病人在早孕期即出現(xiàn)典型的胎盤植入的超聲征象。通過超聲對瘢痕妊娠進(jìn)行分型可以預(yù)測其臨床結(jié)局。第二部分產(chǎn)前不同超聲征象診斷胎盤植入價(jià)值的meta分析目的:應(yīng)用meta分析探討不同的超聲征象在產(chǎn)前診斷胎盤植入的價(jià)值。資料和方法:通過PubMed、Cochrane圖書館、萬方、CNKI及維普數(shù)據(jù)庫上檢索從2006年1月至2016年10月發(fā)表的有關(guān)產(chǎn)前超聲診斷胎盤植入的中英文文獻(xiàn),按照納入和排除標(biāo)準(zhǔn),提取納入文獻(xiàn)中的相關(guān)信息,通過QUADAS-2評價(jià)系統(tǒng)制定質(zhì)量評價(jià)標(biāo)準(zhǔn),針對納入的文獻(xiàn)進(jìn)行質(zhì)量評價(jià)。用Review Manager5.3和Meta-DiSc 1.4統(tǒng)計(jì)軟件計(jì)算納入文獻(xiàn)的不同超聲征象在產(chǎn)前診斷胎盤植入的敏感度、特異度繪制森林圖,匯總敏感度(SEN)、匯總特異度(SPE)及相應(yīng)的95%的置信區(qū)間(CI),得出陰性似然比和陽性似然比、診斷比值比(D0R),針對≥5篇文獻(xiàn)報(bào)道過的征象繪制綜合受試者工作特征曲線(SR0C)及計(jì)算面積(AUC)。結(jié)果:共納入12篇文獻(xiàn),1392例具有植入高風(fēng)險(xiǎn)病例,其中胎盤植入349例。結(jié)果顯示:胎盤后間隙消失/破壞:SEN0.83(0.78-0.88)、SPE0.86(0.83-0.88)、AUC0.9042;胎盤漩渦:SEN0.71(0.67-0.76)、SPE0.83(0.81-0.85)、AUC0.8580;子宮膀朧交界面破壞:SENO.46(0.38-0.54)、SPE 0.98(0.96-0.99)、AUCO.9083;胎盤/子宮膀胱交界面豐富血流信號(hào):SEN0.67(0.60-0.72)、SPE0.95(0.93-0.96)、AUC0.9470;胎盤內(nèi)穿支血流:SEN0.59(0.50-0.68)、SPE0.91(0.88-0.94);局部突出于子宮的腫塊:SEN0.23(0.17-0.32)、SPE0.98(0.96-0.99);胎盤后子宮肌層厚度≤1mm:SEN0.58(0.50-0.66)、SPE0.92(0.89-0.94)。結(jié)論:在高危孕婦中,尤其是前置胎盤伴有剖宮產(chǎn)史或子宮手術(shù)史,不同超聲征象在評估胎盤植入均具有一定的價(jià)值。其中判斷胎盤漩渦時(shí)應(yīng)結(jié)合彩色多普勒漩渦內(nèi)血流信號(hào)。所有征象中,多普勒示胎盤/子宮膀胱交界面豐富血流信號(hào)診斷準(zhǔn)確性最高。
[Abstract]:The first part is to explore the relationship between caesarean scar pregnancy and placental implantation. The purpose of this study is to explore the relationship between caesarean scar pregnancy and placental implantation by ultrasonic diagnosis, to provide more evidence-based evidence for the natural development of scar pregnancy, and to classify the patients with scar pregnancy to understand the different types of cesarean section. The clinical outcome of cicatricial pregnancy patients. Data and methods were collected from January 2014 to February 2017 in 19 cases of caesarean scar pregnancy diagnosed by ultrasound in Qilu Hospital of Shandong University and selected to continue pregnancy management. The ultrasonic images, clinical data and pathological data of the diagnosis of cesarean scar pregnancy and subsequent pregnancy were obtained. The ultrasonic images of cicatricial pregnancy were divided into groups (low risk group and high risk group), and the relationship between two groups of pregnancy outcomes was compared and the relationship between caesarean scar pregnancy and placenta implantation was explored. Results: among 19 cases, 16 (16/19) cases were followed by ultrasound examination of placenta implantation, 18 (18/19) clinical / pathological diagnosis of placenta implantation and ultrasonic diagnosis of placenta The sensitivity of the implant was 88.99%, the positive predictive value of 100%.4 placenta penetrating patients were all in the early pregnancy (12 weeks, 12 weeks, 9 weeks +6 days, 10 weeks) with the placental implantation. The patients were divided into 10 cases of low risk group, 9 cases of high risk group, and two groups of clinical outcomes: the 1100ml in the low risk group of bleeding in the operation was lower than the high risk group 2000ml, P=0.26 9, 9 cases of low risk group (9/10) were higher than high risk group (4/9), P=0.057, 1 cases with low risk of hysterectomy (1/10), 1 cases of high risk group (1/9) and P=1.000; placental penetration 4 (4/9) all appeared in high risk group. P=0.033. conclusion: Caesarean scar pregnancy is closely related to placental implantation, scar pregnancy may be the preplacental table of placental implantation Present form. The ultrasonic signs of typical placental implantation occur in the early pregnancy period of the patients with penetrating placenta. The clinical outcome can be predicted by typing the scar pregnancy by ultrasound. Second parts of the meta analysis of the value of placental implantation for the diagnosis of the prenatal different ultrasound signs: the application of meta analysis to explore the prenatal diagnosis of fetal diagnosis. Value and methods of disc implantation. Data and methods were retrieved from the PubMed, Cochrane library, Wanfang, CNKI, and VP databases on prenatal ultrasound diagnosis of placenta implantation from January 2006 to October 2016. According to the inclusion and exclusion criteria, the relevant information included in the literature was extracted, and the quality of the system was formulated by the QUADAS-2 evaluation system. Quantitative evaluation criteria were used to evaluate the quality of the included literature. Review Manager5.3 and Meta-DiSc 1.4 statistical software were used to calculate the sensitivity, the specificity of the forest map, the SEN, the SPE and the corresponding 95% confidence interval (CI) for the prenatal diagnosis of placenta implantation. The ratio and positive likelihood ratio, the ratio of diagnostic ratio (D0R), the work feature curve (SR0C) and calculation area (AUC) were drawn for more than 5 literature. Results: 12 articles were included, 1392 cases had high risk of implantation, among which 349 placental implants were implanted. The results showed that the post placental space disappearance / destruction: SEN0.83 (0.78-0.88), S PE0.86 (0.83-0.88), AUC0.9042; placental whirlpool: SEN0.71 (0.67-0.76), SPE0.83 (0.81-0.85), AUC0.8580, uterine bladder interface disruption: SENO.46 (0.38-0.54), SPE 0.98 (0.96-0.99); 8), SPE0.91 (0.88-0.94); locally prominent masses of the uterus: SEN0.23 (0.17-0.32), SPE0.98 (0.96-0.99); the thickness of the postplacental uterine myometrium is less than 1mm:SEN0.58 (0.50-0.66) and SPE0.92 (0.89-0.94). Conclusion: in high risk pregnant women, especially placenta previa with the history of cesarean section or uterine surgery, different ultrasound signs are all in the assessment of placenta implantation. The diagnostic value of the placental whirlpool should be combined with the color Doppler vortex in the whirlpool. In all the signs, Doppler shows the highest diagnostic accuracy in the placental / uterine bladder interface with rich blood flow signals.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.1;R714.22

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