产后大出血:卵巢动脉造影和栓塞术的意义

Postpartum Massive Hemorrhage: Clinical Significances of Selective Ovarian Arterial Angiography and Embolization

目的:观察卵巢动脉(OA)作为产后出血来源的血管造影表现,评价经导管栓塞OA参与出血的安全性和疗效。材料和方法:对7例OA作为产后出血来源的患者进行了选择性OA造影和栓塞术。栓塞OA的材料有明胶海绵碎粒、PVA、微型钢丝圈。结果:选择性OA造影显示造影剂外溢至宫腔6例、OA直接参与子宫异常血管供血1例。补充栓塞参与出血或病变的OA后出血立即停止,住院期间未再复发出血,未发生与栓塞术相关的并发症。结论:OA可作为产后出血的主要供血动脉,是导致常规栓塞两侧髂内动脉-子宫动脉不能控制出血的原因之一。如发现OA参与产科出血性病变的供血,补充做OA栓塞术是安全和有效的。

Purpose： To describe the manifestations of the arterial supply to postpartum hemorrhage by the ovarian arteries （OA） and to evaluate the safety and efficacy of transcatheter arterial embolization （TAE） of OA for control of postpartum massive hemorrhage. Materials and Methods： Seven patients with obstetric massive hemorrhage underwent selective OA angiagraphy and embelization in addition to the routine TAE of the hypogastric-uterine arteries. The embolization materials were gelatin sponge particles, polyvinyl alcohol particles （PVA） and mierocoils. Results： Selective angiography of the OA revealed the contrast extravasation in 6 patients and the blood supplying to the uterine lesions via OA in 1 patient. All bleeding ceased immediately after supplemental OA embolization. Recurrent bleeding did not occur in any of the cases during their hospital stay. No major complication related to the embolization procedure was found. Conclusions： Blood supply to the obstetric hemorrhage via an OA may result in clinical failure following the bilateral hypogastric-uterine arterial embolization. Selective OA embolization is a safe and effective adjunct to the hypogastric-uterine arterial embolization in the management of postpartum bleeding supplied by the OA.