动脉栓塞治疗产后出血的临床应用研究

Clinically applied study of transcatheter arterial embolization for treating postpartum hemorrhage

目的评价经导管动脉栓塞术(TAE)治疗产后出血的血管造影表现及疗效。方法65例产后出血患者采用右股动脉Seldinger's穿刺技术,选择性插管至双侧髂内动脉或子宫动脉,行数字减影血管造影(DSA)明确出血原因、部位后用庆大霉素浸泡过的明胶海绵颗粒或条栓塞。结果插管成功率100%,手术时间30～60min,平均45.2±4.8min,术后止血总有效率98.46%。术后随访3～60个月,均无严重并发症发生,子宫体按期复旧,转经后月经正常。结论TAE创伤小,疗效快速肯定,对危及生命的产后出血是一种有效的治疗措施。

Objective To assess the value of angiography and the efficacy of transcatheter arterial embolization in the treatment of postpartum hemorrhage. Methods sixty-five women with postpartum hemorrhage underwent femoral artery puncture by Seldinger＇s technique. Superselective catheterization to the bilateral internal lilac arteries or uterial arterial and then arterial embolization with gelfoam particles soaked in the Gentamycin sulfate was performed after the demonstration of bleeding sources and causes. Results All of the 65 patients with obstetrical bleeding were successfully controlled. TAE lasted 30 - 60 min, mean 45.2±4. 8min. DSA showed diffuse extravasation of contrast agent in 28 cases and bleeding arised from 7 uterus arteries and one pudendal artery. All patients were followed up for 3 - 60 months and no major complication related to embolization therapy was observed. Menstruation resumed in all patienta. Conclution With less complications emergency arterial embolization is a safe and effective means of control postpartum hemorrhage.