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·诊疗分析·

巨大胎盘类血池样病变超声征象与临床诊断分析

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玄英华，王莉 ，黄瑞贞，吴青青 扫描二维码
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【摘要】 目的 探讨不同巨大胎盘类血池样病变的产前超声特征及产前诊断意义。方法 回顾性分析 2016 年
2 月至 2021 年 12 月在首都医科大学附属北京妇产医院进行超声检查时发现巨大胎盘类血池样病变的 6 例患者的临床
资料，分析其一般资料、超声特征、临床诊断及妊娠结局。以最大径线 >5 cm 作为巨大胎盘类血池样病变的定义。结
+6
+2
果 6 例患者均为单胎妊娠，年龄 27~33 岁，首次发现巨大胎盘类血池样异常回声的孕周为 18 ~31 周。3 例（病例 1、
+1
+5
病例 2 及病例 3）类血池样异常回声与胎盘组织有分界，分别于妊娠 33 周、29 周及 32 周行剖宫产，3 例新生儿均
存在尿道下裂畸形，临床诊断均为胎盘绒毛膜板下出血；1 例（病例 4）类血池样病变位于胎盘子面，与胎盘组织有分界，
突向羊膜腔，动态观察可以消失，妊娠期超声监测胎儿生长符合孕周，妊娠后期血池范围明显减小，临床诊断为巨大
胎盘血池；2 例（病例 5 和病例 6）类血池样病变为弥漫性病变，累及大部分胎盘，正常胎盘组织减少，胎儿均为早
发型生长受限（各经线 <1%、腹围为 2.3%），脐动脉舒张末期血流均消失，孕妇子宫动脉舒张早期出现切迹（双侧、
+4
单侧）；病例 5 于妊娠 23 周终止妊娠，病例 6 并发重度子痫前期，于妊娠 27 周终止妊娠，临床诊断均为胎盘灌注
不良合并早发型胎儿生长受限。结论 妊娠期胎盘类血池样异常回声根据其不同形成原因，有各自的超声特征，产前
可以进行鉴别，及时诊断有助于提示严重胎盘灌注不良及绒毛膜板下出血病例产前严密监测胎儿情况，减少不良妊娠
结局的发生。
【关键词】 胎盘；血池；胎儿宫内监测；胎儿宫内生长受限；早发型；尿道下裂；重度子痫前期
【中图分类号】 R 714.56 【文献标识码】 B DOI：10.12114/j.issn.1007-9572.2022.0411
玄英华，王莉，黄瑞贞，等 . 巨大胎盘类血池样病变超声征象与临床诊断分析［J］. 中国全科医学，2022，25（36）：
4567-4572. ［www.chinagp.net］
XUAN Y H，WANG L，HUANG R Z，et al. Ultrasonographic findings and clinical diagnosis of large placental lake-like
lesions：clinical analysis of six cases［J］. Chinese General Practice，2022，25（36）：4567-4572.

Ultrasonographic Findings and Clinical Diagnosis of Large Placental Lake-like Lesions：Clinical Analysis of Six Cases
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XUAN Yinghua，WANG Li ，HUANG Ruizhen，WU Qingqing
Department of Ultrasound，Beijing Obstetrics and Gynecology Hospital，Capital Medical University/Beijing Maternal and Child
Health Care Hospital，Beijing 100026，China
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Corresponding author：WANG Li，Chief physician；E-mail：wangli1971@ccmu.edu.cn
【Abstract】 Objective To discuss prenatal ultrasonographic characteristics of placental lake-like lesions and the
significance of prenatal diagnosis of these lesions. Methods Six patients with prenatal placental lake-like lesions（maximal
diameter>5 cm） detected by ultrasound were selected from Beijing Obstetrics and Gynecology Hospital，Capital Medical
University from February 2016 to December 2021. Their demographic data，ultrasound features，clinical diagnoses and
pregnancy outcomes were retrospectively analyzed. Results All the patients had a singleton pregnancy，aged 27-33 years at
diagnosis，and were initially found with placental lake-like lesions at 18 weeks and two days of pregnancy to 31 weeks and 6
days of pregnancy. Lake-like lesions with clear margins with placenta were detected by ultrasound in cases 1，2 and 3，all of
them were clinically diagnosed with massive subchorionic hematoma（MSH），then underwent ceserean section at less than
34 weeks but greater than 33 weeks of pregnancy，less than 30 weeks but greater than 29 weeks of pregnancy，and 32 weeks of
pregnancy，respectively，and all of 3 neonates had hypospadias. In case 4，a lake-like lesion with definite border protruding
into amniotic cavity was found，which spontaneously disappeared in minutes. Fetal growth was unremarkable during pregnancy.
In follow-up，the lesion was decreased significantly. Final diagnosis was real large placental lake. In cases 5 and 6，lake-like
lesions diffusely involved most part of placenta，with decreased normal placental tissues. Both cases were complicated by early-
onset fetal growth restriction（all biometric parameters<1%，abdominal circumference 2.3%）. Absence of diastolic flow in

100026 北京市，首都医科大学附属北京妇产医院 北京妇幼保健院超声科
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通信作者：王莉，主任医师；E-mail：wangli1971@ccmu.edu.cn
本文数字出版日期：2022-07-21