致死性产后大出血的急诊动脉栓塞治疗

Application of emergency arterial embolization in the treatment of fatal postpartum hemorrhage

目的:探讨超选择性双侧子宫动脉栓塞在致死性产后大出血的急诊抢救中的临床效果及价值。方法:急诊动脉栓塞治疗15例致死性产后大出血患者。术前进行必要的扩容升压处理以稳定生命体征,在影像监视下,穿刺右侧股动脉行双侧超选择性子宫动脉插管,造影证实后,视具体血管影像经导管推注500～700μm的PVA颗粒栓塞子宫动脉末梢支,使用经高温蒸汽消毒的明胶海绵颗粒栓塞子宫动脉主干。结果:1例高龄产妇并发弥漫性内凝血,抢救无效死亡。其余14例患者当即完全止血,无明显的不良反应及并发症。结论:超选择性双侧子宫动脉栓塞治疗致死性产后大出血,是一个高效、安全、易耐受并最大程度保留患者生理功能,保证患者术后生存质量的重要治疗方法,应该成为致死性产后大出血治疗的首选。

Objective：To evaluate the clinical efficiency and value of superselective bilateral uterine artery embolization in the treatment of fatal postpartum hemorrhage.Method：Emergency arterial embolization were applied in 15cases of patients with fatal postpartum hemorrhage.Preoperative volume expansion was necessary to stabilize the vital signs.The catheters were inserted into the bilateral uterine artery under the surveillance of video after puncture of the right femoral artery.After verified by angiography,500to 700μm PVA particles were injected through the catheter to embolize the peripheral branch of uterine artery according to the specific vascular imaging.The uterine artery was embolized by gelatin sponge particles sterilized by high temperature.Result：One case of advanced maternal age died from concurrent diffuse coagulation.The other 14patients stopped bleeding immediately after embolization with no significant side effects and complications.Conclusion：Superselective bilateral uterine artery embolization is an efficient and safe treatment for fatal postpartum bleeding.The patients are well tolerated and the physical function is well retained to the maximum.Besides,the postoperative quality of life may be ensured.Emergency arterial embolization should be the preferred choice for the treatment of fatal postpartum hemorrhage.