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中华产科急救电子杂志 ›› 2026, Vol. 15 ›› Issue (03) : 151 -157. doi: 10.3877/cma.j.issn.2095-3259.2026.03.005

论著

两种胎盘病理取材方法对子宫胎盘血管检出率的对比研究
杨中凤1,2, 秦平1, 刘少颜1, 赵丽1, 于滨3, 谭学贤1, 江庆萍1,()   
  1. 1广州医科大学附属第三医院病理科,广州 510150
    2中山大学附属第七医院病理科,深圳 518106
    3广州医科大学附属第三医院产科 广东省产科重大疾病重点实验室 广东省妇产疾病临床医学研究中心 粤港澳母胎医学高校联合实验室,广州 510150
  • 收稿日期:2025-01-12 出版日期:2026-08-18
  • 通信作者: 江庆萍
  • 基金资助:
    国家自然科学基金科研项目(82172935); 广州市科技计划项目(2024A03J0934)

A comparative study of two placental pathological sampling methods on detection rate of uteroplacental vessels

Zhongfeng Yang1,2, Ping Qin1, Shaoyan Liu1, Li Zhao1, Bin Yu3, Xuexian Tan1, Qingping Jiang1,()   

  1. 1Pathological Department, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou 510150, China
    2The Seventh Affiliated Hospital, Sun Yan-set University, Shenzhen 518106, China
    3Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Guangzhou Medical University, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, Guangzhou 510150, China
  • Received:2025-01-12 Published:2026-08-18
  • Corresponding author: Qingping Jiang
引用本文:

杨中凤, 秦平, 刘少颜, 赵丽, 于滨, 谭学贤, 江庆萍. 两种胎盘病理取材方法对子宫胎盘血管检出率的对比研究[J/OL]. 中华产科急救电子杂志, 2026, 15(03): 151-157.

Zhongfeng Yang, Ping Qin, Shaoyan Liu, Li Zhao, Bin Yu, Xuexian Tan, Qingping Jiang. A comparative study of two placental pathological sampling methods on detection rate of uteroplacental vessels[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2026, 15(03): 151-157.

目的

探讨不同的胎盘病理取材方法对子宫胎盘血管检出率及胎盘病理诊断准确性的影响。

方法

(1)根据不同胎盘部位的超声血流信号,以超声血流动力学为基础提出新的胎盘取材方法(新方法组),与根据Amsterdam共识使用的常规胎盘取材方法(常规方法组)进行胎盘血管检出率及病理诊断准确性的比较;(2)新方法组176例,其中57例临床诊断为妊娠期高血压疾病(hypertensive disorders of pregnancy,HDP),常规方法组129例,其中43例为HDP,比较两种取材方法的子宫胎盘血管检出率及胎盘母体血管灌注不良的诊断率。

结果

(1)新方法组HDP胎盘的子宫胎盘血管检出率明显大于常规方法组(70.2%与39.5%,Z=-3.057,P=0.002);(2)不同胎盘位置取材的比较显示胎盘边缘的血管检出率最高(54.4%,U=13.841,P=0.003);(3)新方法组HDP胎盘母体血管灌注不良的诊断率高于常规方法组(59.6%与32.6%,Z=-2.671,P=0.008)。

结论

新胎盘取材方法可获得更多的子宫胎盘血管供组织病理学评估,展示更全面的病变信息,可提高胎盘病理诊断的准确性,同时规范胎盘取材标准。

Objective

To investigate the influence of different placental pathological sampling methods on the detection rate of uteroplacental vessels and the accuracy of placental pathological diagnosis.

Methods

(1) Based on the ultrasonic blood flow signals of different placental locations, a new placental sampling method was proposed (new method group) and compared with the conventional placental sampling method recommended by the Amsterdam Consensus (conventional method group), in terms of the detection rate of uteroplacental vessels and the accuracy of placental pathological diagnosis. (2) There were 176 patients in the new method group, 57 of whom were clinically diagnosed as hypertensive disorders of pregnancy (HDP); 129 patients in the conventional method group, 43 of whom were HDP. The detection rate of uteroplacental vessels and the diagnostic rate of placental maternal vascular malperfusion (MVM) were compared between the two groups.

Results

(1) In the detection rate of uteroplacental vessels, comparison of HDP placentas showed that the new method group was significantly higher than the conventional method group (70.2% vs 39.5%, Z=-3.057, P=0.002). (2) Comparison of different placental positions showed that the detection rate of blood vessels located at the placental margin was the highest (54.4%, U=13.841, P=0.003). (3) The diagnostic rate of MVM of HDP in the new method group was higher than that in the conventional method group (59.6% vs 32.6%, Z=-2.671, P=0.008).

Conclusions

The new placental sampling method can obtain more uteroplacental vessels for histopathological evaluation and demonstrate more comprehensive lesion information, which improves the accuracy of placental pathological diagnosis and standardizes placental sampling criteria.

图1 两种胎盘取材示意图 A: Amsterdam取材方法取3块胎盘实质,取样部位为胎盘胎儿面中央2/3区域内3块胎盘组织全层(红色圈内)。B、C:新取材方法取4块胎盘实质,取样部位分别为胎盘胎儿面边缘(B红色箭头)、脐带附着处胎盘小叶全层(B橙色箭头),胎盘母体面中央位置胎盘小叶全层(C绿色箭头)及胎盘最厚处胎盘小叶全层(C蓝色箭头)
图2 不同形态子宫胎盘血管的病理图片 A:不规则扩张的血管(孕37周,HE×100);B:血管壁纤维素性坏死(孕35周,合并妊娠期高血压疾病,HE×100);C:急性动脉粥样硬化并伴有炎性细胞浸润(孕35周,合并妊娠期高血压疾病,HE×100);D:图中下部血管重塑良好,上部箭头示血管壁较厚,直径较窄,表明重塑不良(孕34周,HE×40)
表1 两种取材方法子宫胎盘血管检出情况的比较[例(%)]
表2 两种取材方法在HDP患者胎盘中子宫胎盘血管检出情况的比较[例(%)]
表3 57例HDP患者胎盘不同取材位置检出子宫胎盘血管情况的比较[例(%)]
表4 两种取材方法对HDP患者胎盘MVM诊断符合率的比较[例(%)]
表5 新取材方法对HDP与非HDP胎盘血管检出情况的比较[例(%)]
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