發(fā)布時間：2018-03-29 18:05

  本文選題：胎盤植入　切入點：磁共振　出處：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:1.研究在孕晚期胎盤位于不同位置時超聲與磁共振(MRI)對于胎盤植入(Placental implantation abnormality,PIA)的診斷價值;2.探討不同類型胎盤植入(PIA)的危險因素及不同類型PIA危險因素的差異;3.力求提高產(chǎn)前診斷及評估PIA的能力,從而降低PIA相關(guān)并發(fā)癥的發(fā)生率。方法:1.使用回顧性病例研究了在2013年6月至2014年1月山西醫(yī)科大學第一臨床醫(yī)學院住院分娩的66名最終確診為PIA的病例,收集其臨床資料并使用SPSS20.0對超聲及MRI診斷不同位置胎盤植入的靈敏度(sensitivity,Se),特異度(Specificity,Sp),陽性預(yù)測值(positive predictive value,+PV),陰性預(yù)測值(negative predictive value,-PV),約登指數(shù)(Youden’index,YI),似然比(likelihood ratio,LR),符合率(agreement rate)并分別計算其95%置信區(qū)(Confidence Interval,95%CI),分別做出受試者工作特征曲線(ROC曲線),從而進行對比。2.收集2015年1月至2015年12月于山西醫(yī)科大學第一臨床醫(yī)學院住院分娩,術(shù)后病理結(jié)果診斷為胎盤植入患者86例、胎盤粘連的患者50例,與114例非胎盤植入患者,記錄其年齡、孕周、人工流產(chǎn)次數(shù)及既往剖宮產(chǎn)次數(shù),并行回顧性分析。結(jié)果:1.胎盤植入的發(fā)病率為5.54%-8.23%。2.胎盤植入超聲診斷的Se(95%CI)、Sp(95%CI)、YI、+PV,-PV,+LR,-LR,Agreement rate結(jié)果分別為77.8%(67.8-87.8),76.7%(66.5,86.9),54.5%,80.0%,74.2%,3.34,0.29,77.3%。3.超聲用于胎盤位于前壁的病例的Se(95%CI)、Sp(95%CI)、YI、+PV,-PV,+LR,-LR,Agreement rate的結(jié)果,數(shù)據(jù)分別為83.3%(70.1,96.5),84.6%(71.9,97.3),67.9%,88.2%,78.6%,5.41,0.20,83.9%。4.超聲用于胎盤位于后壁及側(cè)壁的病例的診斷Se(95%CI)、Sp(95%CI)、YI、+PV,-PV,+LR,-LR,Agreement rate結(jié)果,數(shù)據(jù)分別為72.2%(57.4,87.0),70.6%(55.5,85.7),42.8%,72.2%,70.6%,2.46,0.39,71.4%。5.MRI診斷胎盤植入的Se(95%CI)、Sp(95%CI)、YI、+PV,-PV,+LR,-LR,Agreement rate結(jié)果分別為81.0%(64.6,97.4),100.0%(100.0,100.0),81.0%,100.0%,20.0%,5.26,0.00,81.8%。6.孕婦的年齡每增長1歲,胎盤植入及侵襲性胎盤植入的發(fā)病風險也相應(yīng)增長12.5%,孕次每增多1次,胎盤植入劑侵襲性胎盤植入的發(fā)病風險增長72.6%,既往剖宮產(chǎn)次數(shù)每加1次,胎盤植入及侵襲性胎盤植入的發(fā)病風險增長264.6%,胎盤粘連的發(fā)生與以上危險因素并無明顯相關(guān)性。結(jié)論:高齡、既往剖宮產(chǎn)史、孕次增多均為PIA的危險因素,其中剖宮產(chǎn)次數(shù)的增多可使胎盤植入的發(fā)生率成倍增長。磁共振在診斷胎盤植入具有補充作用,尤其是對于后壁胎盤的胎盤植入病例診斷價值優(yōu)于超聲。
[Abstract]:Objective: To study the 1. different positions is ultrasonography and magnetic resonance imaging (MRI) in placenta for placenta implantation (Placental implantation abnormality, PIA) the diagnostic value of 2.; explore the different types of placenta implantation (PIA) between the risk factors and risk factors of different types of PIA; 3. in order to improve the ability of prenatal diagnosis and assessment of PIA the incidence rate of PIA, thereby reducing the complications. Methods: 1. cases were retrospectively studied 66 patients diagnosed with hospital delivery in the first clinical medical college of Shanxi Medical University from June 2013 to January 2014 for cases of PIA disease, the clinical data collection and use SPSS20.0 on the sensitivity of ultrasound and MRI in diagnosis of placenta implantation in different positions (sensitivity, Se) specificity, (Specificity, Sp), positive predictive value (positive predictive value, +PV), negative predictive value (negative predictive value, -PV), Jorden (Youden index, Y 'index I (likelihood ratio), likelihood ratio, LR), the coincidence rate (agreement rate) and calculate the 95% confidence interval (Confidence, Interval, 95%CI) were made by the receiver operating characteristic curve (ROC curve), which were collected from January 2015 to December 2015 compared to.2. in the first clinical medical college of Shanxi Medical University hospital, postoperative results the pathological diagnosis of 86 cases of patients with placenta implantation, 50 cases of patients with Placenta Adhesion, and 114 cases of non patients with placenta implantation, recording the age, gestational age, number of abortions and previous cesarean, parallel retrospective analysis. Results: the incidence rate of placenta implantation 1. implanted placenta ultrasound diagnosis of 5.54%-8.23%.2. (Se 95%CI), Sp (95%CI), YI, +PV, -PV, +LR, -LR, Agreement and rate results were 77.8% (67.8-87.8), 76.7% (66.5,86.9), 54.5%, 80%, 74.2%, 3.34,0.29,77.3%.3. ultrasound for placenta located in the anterior wall in case of Se (95%CI), Sp (95%CI) YI, +PV, -PV, +LR, -LR, Agreement, rate, data were 83.3% (70.1,96.5), 84.6% (71.9,97.3), 67.9%, 88.2%, 78.6%, 5.41,0.20,83.9%.4. ultrasound in the diagnosis of Se is located on the back wall and the side wall of the case of the placenta (95%CI), Sp (95%CI), YI, +PV, -PV +LR, -LR, Agreement, rate, data were 72.2% (57.4,87.0), 70.6% (55.5,85.7), 42.8%, 72.2%, 70.6%, 2.46,0.39,71.4%.5.MRI diagnosis of placenta accreta Se (95%CI), Sp (95%CI), YI, +PV, -PV, +LR, -LR, Agreement and rate results were 81% (64.6,97.4), 100% (100.0100.0), 81%, 100%, 20%, 5.26,0.00,81.8%.6. of pregnant women 1 years of age for each growth, the risk of placenta implantation and invasive placenta implantation has also increased 12.5%, every 1 increase in pregnancy, placenta implants invasive placenta implantation risk increase of 72.6%, previous cesarean section plus 1 times each the invasion, placenta implantation and placenta implantation The risk of an increase of 264.6%, the incidence of placental adherence and more risk factors have no obvious correlation. Conclusion: age, previous history of cesarean section, increase pregnancy are risk factors for PIA, including the number of cesarean section increased the incidence of placenta implantation exponentially. MRI has a supplementary role in the diagnosis of placenta implantation in particular, diagnosis value of placenta implantation is superior to ultrasound for wall placenta.

【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.462;R445

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