探讨前置胎盘合并胎盘植入患者子宫切除的相关影响因素。

回顾性分析2017年1月至2021年10月广州医科大学附属第三医院收治孕28周以后分娩的前置胎盘合并胎盘植入444例患者的临床资料，子宫切除患者为研究组(152例，34.2%)，无子宫切除患者为对照组(292例，65.8%)。对两组患者的一般情况、既往剖宫产相关因素和手术相关因素等行单因素分析，并采用Logistic回归行多因素分析。

两组患者产次(≤1次：69.18% vs 43.42%; 2次：27.40% vs 46.71%; ≥3次：3.42% vs 9.87%; χ²＝29.323)、有前置胎盘病史(3.42% vs 9.87%, χ²＝7.757)、既往剖宫产次数(0次：23.63% vs 7.24%; 1次：56.85% vs 47.37%；≥2次：19.52% vs 45.39%; χ²＝40.168)、术中失血量(900 ml vs 1500 ml; Z＝－8.164)、胎盘植入程度(粘连：82.19% vs 34.87%；植入：13.36% vs 23.03%；穿透：4.45% vs 42.11%; χ²＝121.255)、首次诊断胎盘植入孕周(<12周：0.34% vs 5.26%; 12~27⁺⁶周：29.11% vs 55.92%; ≥26周：70.55% vs 38.82%; χ²＝47.637)的差异均有统计学意义(P<0.05)。Logistic回归分析示，产次、胎盘植入程度、术中出血量及首次诊断胎盘植入孕周是前置胎盘合并胎盘植入子宫切除的独立危险因素。

产次、胎盘植入程度、术中出血量及首次诊断胎盘植入孕周是前置胎盘合并胎盘植入子宫切除的独立危险因素。越早诊断胎盘植入，随产次增多、胎盘植入程度加重，子宫切除的风险明显增加，重视此类患者的产前保健、术前风险评估，对减少子宫切除风险至关重要。

To investigate the related factors of hysterectomy in patients with placenta previa combined with placenta accrete.

From January 2017 to October 2021, the clinical data of 444 patients with placenta previa combined with placenta accrete who delivered after the 28th week of pregnancy in the Third Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. Among them, 152 patients (34.2%) had a hysterectomy as the research group, and 292 patients (65.8%) had no hysterectomy as the control group. Univariate analysis was performed on the general situation, factors related to the previous cesarean section, and factors related to operation in the two groups, and multivariate analysis was performed by Logistic regression.

There were statistically significant differences between the two groups in pregnancy times (≤1次: 69.18% vs 43.42%; 2次: 27.40% vs 46.71%; ≥3次: 3.42% vs 9.87%; χ²=29.323), history of placenta previa (3.42% vs 9.87%, χ²=7.757), previous cesarean section times (0次: 23.63% vs 7.24%; 1次: 56.85% vs 47.37%; ≥2次: 19.52% vs 45.39%; χ²=40.168), gestational age of first diagnosis of placenta previa (<12 weeks: 0.34% vs 5.26%; 12~27^{+ 6} weeks: 29.11% vs 55.92%; ≥26 weeks: 70.55% vs 38.82%; χ²=47.637), intraoperative blood loss (900 ml vs 1500 ml; Z=-8.164), placenta implantation degree (adhesions: 82.19% vs 34.87%; implantation: 13.36% vs 23.03%; penetration: 4.45% vs 42.11%; χ²=121.255)(P<0.05). Logistic regression analysis showed that parity, degree of placenta accreta, intraoperative blood loss and gestational age of first diagnosis of placenta accreta were independent risk factors for placenta previa combined with placenta accrete hysterectomy.

The parity, the degree of placenta accreta, the amount of intraoperative blood loss and the gestational age of the first diagnosis of placenta accreta are independent risk factors for placenta previa combined with placenta accrete hysterectomy. The earlier the diagnosis of placenta accreta, the higher the parity and the degree of placenta accreta, and the greater the risk of hysterectomy. Paying attention to prenatal care and preoperative risk assessment of such patients are essential to reduce hysterectomy.