本文選題：超聲微泡　切入點(diǎn)：胎盤　出處：《重慶醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過比較微泡造影劑造影前后胎盤二維圖像上的細(xì)微變化，從而為評估胎盤的結(jié)構(gòu)、大小、位置、是否存在發(fā)育異常等提供更為準(zhǔn)確的超聲圖像。期待尋找一種可以進(jìn)一步提高胎盤植入、前置胎盤、胎盤早剝等疾病的超聲診斷準(zhǔn)確率的影像學(xué)診斷方法，評估超聲造影技術(shù)在胎盤疾病診斷中的應(yīng)用價值。 方法：隨機(jī)選擇12名需要引產(chǎn)的孕婦參與研究，所有參加者均自愿并簽署知情同意書。其中8名孕婦因?yàn)樘浩鞴侔l(fā)育異�；蛱喝旧w異常需要醫(yī)學(xué)引產(chǎn)，1名孕婦因合并嚴(yán)重甲狀腺功能異常需要引產(chǎn)，其余3名孕婦因?yàn)闊o生育指標(biāo)要求引產(chǎn)，另外1例術(shù)中發(fā)現(xiàn)胎盤植入的產(chǎn)婦也參與了該項(xiàng)試驗(yàn)。試驗(yàn)選用聲諾維（SonoVue）作為超聲影像學(xué)示蹤劑。試驗(yàn)開始前，通過靜脈通道快速注入超聲造影劑，，然后立即在超聲診斷儀（PHILIPS IU-22）二維造影模式下觀察聲諾維在胎盤組織中的顯影情況，對比判斷造影前后超聲圖像異同，從而判斷造影劑的使用能否提高胎盤疾病超聲診斷的準(zhǔn)確性。 結(jié)果：造影劑推入后，胎盤部位出現(xiàn)了明顯的回聲增強(qiáng)，呈現(xiàn)高回聲區(qū)，而子宮肌層回聲較胎盤回聲稍低，胎兒部位呈現(xiàn)無回聲區(qū)。對比造影前圖像，造影后胎盤小葉結(jié)構(gòu)、位置、大小及附著部位界限顯示更清晰。胎盤植入病人造影圖像中發(fā)現(xiàn)子宮肌層近內(nèi)膜線部位出現(xiàn)一個明顯三角形異常信號部位，其內(nèi)回聲強(qiáng)弱不等，邊緣為明顯高回聲并與內(nèi)膜線連續(xù)，其余部分的子宮肌層依舊呈現(xiàn)稍高回聲區(qū)，肌層與宮腔回聲強(qiáng)度差異明顯,而造影前圖像未提示子宮肌層回聲強(qiáng)弱不等,并且子宮肌層與宮腔的回聲強(qiáng)度也無明顯差異。 結(jié)論：我們的研究結(jié)果一方面證明超聲微泡造影劑的使用，能提高胎盤部位的超聲圖像顯示效果，較普通二維圖像更清晰識別胎盤小葉，胎盤與肌層附著關(guān)系；另一方面說明胎兒部位無造影劑顯影，可能提示造影劑未通過胎盤屏障進(jìn)入胎兒體內(nèi)，造影劑可能對胎兒無有害影響。
[Abstract]:Objective: to evaluate the structure, size and location of placenta by comparing the subtle changes in two-dimensional placenta images before and after microbubble contrast medium angiography. Looking forward to finding an imaging diagnostic method that can further improve the diagnostic accuracy of placenta accreta, placenta previa, placental abruption and other diseases. To evaluate the value of contrast-enhanced ultrasonography in the diagnosis of placental diseases. Methods: twelve pregnant women who needed induced labor were randomly selected to participate in the study. All participants volunteered and signed informed consent. Among them, 8 pregnant women needed medical induction of labor due to fetal organ dysplasia or fetal chromosomal abnormalities. One pregnant woman needed to induce labor due to severe thyroid dysfunction. The remaining three pregnant women required induction of labor because they had no fertility indicators. Another woman who had found placenta accreta during the operation also participated in the trial. Sono Vue was selected as an ultrasound imaging tracer. Before the trial began, The ultrasound contrast agent was injected quickly through the vein channel, and then the development of sonovir in placental tissue was observed immediately under the mode of ultrasound diagnostic instrument PHILIPS IU-22), and the difference and similarities of ultrasound images before and after contrast were judged. So as to determine whether the use of contrast media can improve the accuracy of ultrasound diagnosis of placental diseases. Results: after the contrast agent was pushed into the placenta, there was obvious echo enhancement in placenta, which appeared hyperechoic area, while the echo in myometrium was a little lower than that in placenta, and the fetal area was anechoic. Compared with the pre-contrast image, the structure of placental lobules appeared after contrast. The location, size and boundary of the attachment site were more clear. In the placenta accreta patients, an obvious triangular abnormal signal was found in the myometrium near the endometrial line, and the echo intensity was different. The edge of uterine myometrium was hyperechoic and continuous with the endometrial line. The myometrium of the rest of uterus still showed a slightly hyperechoic area, and the intensity of the myometrium was significantly different from that of the uterine cavity. There was no significant difference in echo intensity between myometrium and uterine cavity. Conclusion: on the one hand, our results show that the use of ultrasound microbubble contrast agent can improve the display effect of placenta, and identify the placental lobules and the relationship between placenta and myometrium more clearly than ordinary two-dimensional images. On the other hand, there is no contrast agent in the fetus, which may indicate that the contrast agent does not enter the fetus through the placental barrier, and the contrast agent may have no harmful effect on the fetus.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R71

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