·临床诊疗提示·

    完全性胎盘植入患者成功保守治疗三例诊疗经过

    曹娟，范琦慧，赵羽玲，梅海炳，严海雅，宣兰萍

    作者单位：315000浙江省宁波市妇女儿童医院产科

    通信作者：范琦慧，315000浙江省宁波市妇女儿童医院产科；

    E-mail：1219506010@qq.com

    【摘要】近年来，随着剖宫产率的升高，胎盘植入发病率及其并发症发生率呈持续上升趋势，既往治疗多以切除子宫来保全患者的生命，但年轻患者也失去生育器官。完全性胎盘植入临床较为罕见，尚缺乏统一的治疗指南。本研究报道了3例完全性胎盘植入患者成功保守治疗的诊疗经过。患者经B超、MRI及剖宫产术发现完全性胎盘植入。保留胎盘于宫腔内，术后行超选择性子宫动脉内灌注甲氨蝶呤50 mg联合子宫动脉栓塞术，并给予米非司酮口服辅助治疗，广谱抗生素静脉滴注预防感染，取得良好效果。

    【关键词】侵入性胎盘；子宫动脉栓塞术；甲氨蝶呤；保守治疗

    【中图分类号】R 714.462

    收稿日期：(2015-03-14；修回日期：2015-08-18)

    曹娟，范琦慧，赵羽玲，等.完全性胎盘植入患者成功保守治疗三例诊疗经过[J].中国全科医学，2015，18(35)：4374-4377.[www.chinagp.net]

    Cao J， Fan QH,Zhao YL,et al.Process of successful conservative treatment of three cases of complete placenta implanation[J].Chinese General Practice，2015，18(35)：4374-4377.

    Process of Successful Conservative Treatment of Three Cases of Complete Placenta ImplanationCAOJuan，FANQi-hui,ZHAOYu-ling,etal.DepartmentofObstetrics，NingboWomenandChildren′sHospital，Ningbo315000,China

    Abstract【】In recent years,with the increase of cesarean section rate,the incidence of placenta implantation and the incidence of its complications are also increasing.In previous treatment,the removal of the uterus was always conducted to save patients′ life,and in such case many young patients lost reproductive organ.Complete placenta implanation is clinically rare,while there is a lack of uniform treatment guideline.The study reported the process of the successful conservation treatment of three cases of complete placenta implanation.Complete placenta implanation was found in the three patients by B ultrasound,MRI and cesarean section.Placenta was remained in uterine cavity,ultra-selective uterine artery was administrated with selective uterine artery infusion of 50 mg methotrexate combined with uterine arterial embolization,an adjuvant therapy of oral administration of mifepristone was given to the patients,and intravenous drip of wide-spectrum antibiotics were also administrated to prevent infection.The therapy brought favorable effects for the three patients. ......