超选择性动脉插管栓塞对产科大出血的治疗和预防

Super sclective transcatheter angiographic embolization:an effective and prophylactic treatment for massive obstetric haemorrhage

目的探讨经导管动脉栓塞术(TAE)治疗和预防产科大出血的疗效及安全性。方法产科大出血或有大出血风险的病例17例(其中已出现大出血病例14例),包括产后或流产术后出血10例,葡萄胎出血4例。3例预防性栓塞,包括胎盘前置2例,宫颈妊娠1例。选择性插管至双侧子宫动脉或髂内动脉,行DSA明确子宫血管情况,以直径1～3mm明胶海绵颗粒及明胶海绵条或聚乙烯醇(PVA)栓塞,部分病例经子宫动脉灌注甲氨喋呤(MTX)。结果插管成功率100%,14例大出血病例栓塞后活动性出血停止,手术成功,1～5d后阴道内完全无流血。3例预防性栓塞患者,栓塞后行引产术,1例发生大出血,2例未发生大出血。结论TAE创伤小,疗效快速肯定,且并发症少,对产科大出血是一种有效的治疗措施,对有大出血风险的病例预防应用可降低大出血或死亡的风险。

Objective To discuss the effect and safety of transcatheter angiographic embolization（TAE）for managing massive obstetric haemorrhage.Methods 17 cases of obstetric massive haemorrhage or with haemorrhage tendency were treated with TAE.Among them 14 cases had haemorrhage already,including 10 cases after abortion,caesarean section or normal labor and other 4 of hydatidiform mole.3 cases with obstetric haemorrhage tendancy included 2 cases of placenta praevia and 1 case of cervical pregnancy.Selective catheterization into bilateral uterine arteries or internal iliac arteries for DSA,showed the cause and location of the haemorrhage and then embolized with gelform sponge chips（1-3 mm） or Polyvinyl Alcohol（PVA）;and part of the cases with MTX through uterine arterial perfusion.Results The successful rate of catheterization was 100%.The achievement in 14 cases showed no active haemorrhage immediately after the procedure and no vaginal bleeding after 1-5 days.In 3 prophylactic cases before abortion or uterine curettage,obstetric massive haemorrhage occurred in 1 case,but not so in other 2 cases.Conclusions TAE is an effective treatment for obstetric massive haemorrhage,with the advantages of minimal trauma,fast and definite treating effect and less complications.Prophylactical application for high risk patients can reduce the bleeding and mortality.