关键词: 持续性胎盘植入, 宫腔镜, B型超声, 人绒毛膜促性腺激素, 米非司酮, 甲氨蝶呤

Abstract: Objective To  evaluate the safety and effectiveness  of hysteroscope in diagnosis and treatment of retained placenta accreta by comparing the clinical effects of two methods of hysteroscope and medicine  in treatment of  placenta accreta.Methods A retrospective analysis  of fourty-seven patients with retained placenta accreta  including  7 cases of placenta accreta,38 cases of placenta increta,2 cases of  placenta percreta.There were 7 cases in first trimester,19 cases in second trimester,and 21 cases in last trimester.38 patients with placenta increta were treated with hysteroscopic resectin(n=20) and mifeprist
one+methotrexate(n=18),respectively.The clinical effects of two methods were compared by detecting the B ultrasound negative rate,negative rate of human chorionic gonadotropin(HCG) and 3-month normal menstruation rate.Results The risk factors of placenta accreta in various trimesters were basically c
onsistent. Among them curretage was the first risk factor of   placenta accrete,65.9%(31/47)；the second was cesarean,34.0%(16/47).85.7%（6/7） placenta accrete was placenta accrete in first trimester； 92.5%（37/40） was placenta increta in second and third trimesters. 27 cases were cured by
hysteroscopic resection controlled by B ultrasound.A simultaneous laparoscopy was performed in 1 case.19 cases were completed in one operation,and 1 case underwent two operations.There was no complication.The B ultrasound negative rate and 3-month normal menstruation rate in hysteroscope group(100%,100%) were higher than those in medicine group(64.7%，58.8%)(P<0.05).There was no significant difference of negative rate of HCG between two groups(P>0.05).Conclusion The treatment of combined hysteroscope and B ultrasound is more effective than medicine.

Key words: retained placenta accreta, hysteroscope, B ultrasound, human chorionic gonadotropin, mifepristone, methotrexate