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中华医学超声杂志(电子版) ›› 2021, Vol. 18 ›› Issue (09) : 858 -861. doi: 10.3877/cma.j.issn.1672-6448.2021.09.008

介入超声影像学

超声引导下平阳霉素治疗胎盘植入的疗效分析
赵军凤1, 钱林学1,(), 谭小蕖1, 刘玉江1   
  1. 1. 100050 首都医科大学附属北京友谊医院超声科
  • 收稿日期:2020-03-05 出版日期:2021-09-01
  • 通信作者: 钱林学
  • 基金资助:
    北京市医院管理局“登峰”人才培养计划(DFL20180102)

Efficacy of ultrasound-guided pingyangmycin sclerotherapy in treatment of placental implantation

Junfeng Zhao1, Linxue Qian1,(), Xiaoqu Tan1, Yujiang Liu1   

  1. 1. Department of Ultrasound, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
  • Received:2020-03-05 Published:2021-09-01
  • Corresponding author: Linxue Qian
引用本文:

赵军凤, 钱林学, 谭小蕖, 刘玉江. 超声引导下平阳霉素治疗胎盘植入的疗效分析[J]. 中华医学超声杂志(电子版), 2021, 18(09): 858-861.

Junfeng Zhao, Linxue Qian, Xiaoqu Tan, Yujiang Liu. Efficacy of ultrasound-guided pingyangmycin sclerotherapy in treatment of placental implantation[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(09): 858-861.

目的

探讨超声引导下平阳霉素硬化治疗胎盘植入的疗效价值。

方法

选取2014年1月至2017年10月首都医科大学附属北京友谊医院分娩后彩色多普勒超声及MRI均诊断胎盘植入的患者12例,氨甲蝶呤疗效不满意,经腹壁超声引导下胎盘植入处注入平阳霉素,观察术后血人绒毛膜促性腺激素(HCG)及胎盘植入体积变化,并观察术后并发症情况。

结果

12例患者术后(21±11)d血HCG均降至阴性,下降率(99.95±0.07)%,胎盘植入体积缩小率为(59.59±8.18)%,且与子宫肌壁分界尚清;3例患者术后1~2 d出现低热。清宫术后约1周,子宫内膜厚度为0.5~0.8 cm,清宫术后(32±13)d月经来潮。

结论

超声引导下平阳霉素注入可有效辅助治疗胎盘植入,为治疗方向提供帮助。

Objective

To evaluate the efficacy of ultrasound-guided pingyangmycin sclerotherapy for placenta accreta.

Methods

Twelve patients after childbirth were diagnosed with placenta accrete by color Doppler ultrasound and MRI at our hospital from January 2014 to October 2017. The efficacy of methotrexate was not satisfactory. Pingyangmycin was injected into the implanted placenta under the guidance of abdominal ultrasound. Then, the changes of human chorionic gonadotropin (HCG) in the blood, placental volume, and postoperative complications were observed.

Results

The HCG in the blood of the 12 patients were negative (21±11) days post sclerotherapy, with a decline rate of (99.95±0.07)%. The placental volume reduction rate was (59.59±8.18)%, and the implanted placenta had a relatively clear boundary with the uterine muscular wall. Three patients developed low fever 1-2 days post sclerotherapy. The thickness of the endometrium was about 0.5-0.8 cm about 1 week post curettage, and menstrual cramp occurred (32±13) days after curettage.

Conclusion

Ultrasound-guided Pingyangmycin sclerotherapy can effectively assist in the treatment of placental implantation.

图1 29岁女性产后胎盘植入MRI及超声显像图。图a为MRI显示子宫肌壁团状软组织信号,超过肌层厚度2/3;图b为灰阶超声显示子宫腔内中高回声团,与子宫后壁肌壁分界不清,且子宫后壁肌壁回声不明显;图c为彩色多普勒超声声像图,显示胎盘植入部分与子宫肌壁处血流信号丰富
图2 经腹壁超声引导下平阳霉素注入胎盘植入处(箭头所示处为介入针尖)
表1 平阳霉素注入后胎盘植入患者血人绒毛膜促性腺激素及胎盘植入体积变化(%)
图3 胎盘植入患者应用平阳霉素硬化治疗后灰阶超声显像及MRI图。图a为灰阶超声显示宫腔内不均质高回声团,与子宫肌壁回声分界尚清;图b为MRI显示子宫腔内团状软组织信号,与子宫肌壁分界尚清
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