急诊动脉栓塞治疗产后大出血的临床疗效观察

Clinical application of artery embolization for acute primary postpartum hemorrhage

目的探讨产后大出血急诊介入栓塞止血的价值。方法对21例产后大出血患者实施急诊髂内动脉插管术,通过数字减影血管造影(DSA)明确出血部位,超选择性用明胶海绵栓塞子宫动脉或髂内动脉。结果 DSA显示出血均来源于单侧或双侧子宫动脉,表现为对比剂在宫腔内呈弥漫性、局灶性分布。21例产后大出血患者全部栓塞成功,随访3个月～2年无复发。结论介入治疗应用于晚期产后出血具有止血快、疗效确切、手术时间短及并发症少等优点,值得临床推广使用。

Objective To evaluate urgent selective arterial embolization to treat massive postpartum hemorrhage. Methods Twenty-one cases with postpartum hematorrhea were treated emergently by Seldinger catheterization of internal iliac artery,and the uterine arteries or internal iliac artery were embolized super selectively by gelatin sponge after the hemorrhagic site were found by DSA. Results DSA angiography showed that the hemorrhage came from one side or double sides of uterine artery as diffused or focal uterine cavity bleeding or branch bleeding of uterine cavity. Selective catheterization and embolotherapy were successful in all cases of acute primary postpartum hemorrhage without any serious complications. Follow up for 3-24 months, no recurrent hemorrhage was observed. Conclusion With very short procedure time and few complications, interventional radiology is proved to be a very effective treatment for severe postpartum hemorrhage and and it is worth to popularize.