| 杜金超,吕富荣,刘柳恒,赵建宁,杨华.产前MRI预测预防性腹主动脉球囊阻断术加剖宫产治疗胎盘植入预后[J].中国医学影像技术,2019,35(9):1370~1374 |
| 产前MRI预测预防性腹主动脉球囊阻断术加剖宫产治疗胎盘植入预后 |
| Prenatal MRI for predicting prognosis after balloon occlusion of abdominal aorta-assisted cesarean section in patients with placenta accreta |
| 投稿时间：2019-03-07 修订日期：2019-07-08 |
| DOI：10.13929/j.1003-3289.201903049 |
| 中文关键词: 胎盘,侵入性 子宫切除术 磁共振成像 |
| 英文关键词:placenta accreta hysterectomy magnetic resonance imaging |
| 基金项目:国家临床重点专科建设项目（国卫办医函[2013]544号）。 |
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| 中文摘要: |
| 目的 评价产前MRI征象预测预防性腹主动脉球囊阻断术加剖宫产术治疗胎盘植入（AABC-CS）预后的价值。方法 回顾性分析86例因胎盘植入接受AABC-CS患者产前MRI，根据患者预后分为预后良好组（n=50，术中出血量<1 000 ml且未切除子宫）和预后不良组（n=36，术中出血量≥ 1 000 ml或切除子宫），比较2组间MRI征象差异，采用多因素Logistic回归分析获得预测预后不良的危险因素，并计算其预测效能。结果 胎盘内异常血管信号、T2低信号带、胎盘局部凹陷征及胎盘穿透在预后不良组中更常见（P均<0.001）；多因素Logistic回归分析显示胎盘内异常血管信号[比值比（OR）=15.78，P=0.015]、胎盘穿透（OR=12.25，P=0.020）是患者预后不良的危险因子，其预测预后不良的敏感度和特异度分别为77.78%（28/36）、62.00%（31/50）和44.44%（16/36）、100%（50/50）。结论 产前MRI显示胎盘内异常血管信号和胎盘穿透是胎盘植入患者预防性AABC-CS术中大出血和子宫切除的危险因子。 |
| 英文摘要: |
| Objective To explore the value of prenatal MRI for predicting prognosis after balloon occlusion of abdominal aorta-assisted cesarean section (AABC-CS) in patients with placenta accreta. Methods Prenatal MRI of 86 patients underwent AABC-CS due to placenta accreta were reviewed retrospectively. According to the prognosis, the patients were divided into good prognosis group (intraoperative blood loss <1 000 ml and unremoved uterus, n=50) and poor prognosis group (intraoperative blood loss ≥ 1 000 ml or uterus removed, n=36). MRI signs between the 2 groups were compared, and multivariate Logistic regression analysis was used to obtain the risk factors for predicting poor prognosis, and the predictive efficacy was calculated. Results MRI signs of abnormal intraplacental vascularity, hypointense intraplacental bands, uterine recess, placenta percreta were significantly more common in poor prognosis group (all P<0.001). Multivariate Logistic regression analysis showed that abnormal intraplacental vascularity (odds ratio[OR]=15.78, P=0.015) and placenta percreta (OR=12.25, P=0.020) were risk factors for poor prognosis, with sensitivity and specificity of 77.78% (28/36), 62.00% (31/50) and 44.44% (16/36), 100% (50/50), respectively. Conclusion Prenatal MRI signs of abnormal intraplacental vascularity and placenta percreta might be the predictors of intraoperative significant hemorrhage and hysterectomy after AABC-CS in patients with placenta accreta. |
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