血管性介入治疗在妇产科大出血中的临床应用：35例分析

Clinical application of interventional therapy in gynecologic and obstetric massive hemorrhage： analysis of 35 cases

目的评价血管性介入治疗在妇产科大出血疾病中的效果及应用价值。方法对本院妇产科35例大出血患者共38次急诊数字减影血管造影（DSA）下行超选择性子宫动脉或髂内动脉栓塞治疗。结果1例插管失败，1例因严重弥漫性血管内凝血（DIC）改行手术治疗，3例行2次介入治疗，其中1例第2次介入治疗失败，介入治疗后止血有效率为94．6％（35／37），子宫切除率8．6％（3／35），一次栓塞治愈率为85．7％（30/35），达到血止保全子宫等较好的疗效，随访无严重并发症，不影响女性生理。结论血管性介入治疗在治疗妇产科大出血疾病方面安全有效。值得推广。

Objective To evaluate the efficacy and value of emergent interventional therapy in the treatment of gynecologic and obstetric massive hemorrhage diseases. Methods Thirty-five female patients with massive gynecologic and obstetric hemorrhage caused by a variety of diseases, aged 28.2 （20~49）, were treated by superselective uterine arterial embolization or internal iliac arterial embolization uncter＇ digital subtraction angiography （DSA） for 38 times. Results Intubation failure was seen in 1 case, and 1 case had no choice but to undergo hysterectomy because of serious disseminated intravascular coagulation （DIC）. Interference therapy was conducted twice in 3 cases, one of which suffered the failure of the second procedure. The effective hemostasis rate of interference therapy was 94.6% （ 35/37 ） ,the hysterectomy rate was 8.6% （3/35）,the immediate cure rate of embolization was 85.7% （30/35）. The effects in successful hemostasis and preservation of uterus were achieved. No severe complication occurred and the female physiological functions were not influenced. Conclusion Arterial embolization is safe and effective in treating the acute massive hemorrhage in obstetrics and gynecology.