超选择子宫动脉栓塞术治疗难治性产后出血的临床分析

Superselective Uterine Arterial Embolization for Intractable Postpartum Hemorrhage

目的探讨超选择子宫动脉栓塞术治疗难治性产后出血的临床效果。方法回顾分析荆门市第一人民医院2002年1月至2009年12月对难治性产后出血行超选择子宫动脉栓塞和子宫切除治疗的病例临床资料,行超选择子宫动脉栓塞术组23例,行子宫切除术组17例,对两组止血效果、止血时间(术前准备时间及手术时间)、出血量和术后并发症及预后进行分析。结果两组止血效果均达到100%,差异无统计学意义;超选择子宫动脉栓塞术平均术前准备时间(15.2±3.1)min,手术时间(29.8±5.5)min,子宫切除术平均术前准备时间(31.0±4.6)min,手术时间(43.0±8.8)min,两组比较差异有统计学意义(均P<0.05);超选择子宫动脉栓塞术平均出血量(2 920±408)mL,子宫切除术平均出血量(3 114±327)mL,两组比较差异无统计学意义(P>0.05)。超选择子宫动脉栓塞及子宫全切术术后均有少数患者出现并发症,差异无统计学意义。结论超选择子宫动脉栓塞术及子宫切除术均是治疗产后出血的有效方法,超选择子宫动脉栓塞术具有止血迅速、疗效可靠、创伤小的优点,在积极挽救产妇生命的同时保留其生育功能,具有很高的临床应用价值,若不能在短时间内行子宫动脉栓塞术或栓塞术后不能在短时间内止血者,应立即行子宫切除术。

Objective To investigate the superselective uterine arterial embolization（SUAE）for intractable postpartum hemorrhage（IPH）.Methods The clinical data of IPH subject to SUAE（n=23）or hysterectomy（n=17）from January 2002 to December 2009 in our hospital were retrospectively analyzed.The hemostasis,hemostatic time（preoperative preparation time and operative time）,blood loss and postoperative complications and prognosis were examined.Results Hemostatic effects of the two groups reached 100%,without significant difference.In SUAE group,average preoperative preparation time and operating time was（15.2±3.1）min and（29.8±5.5）min,and those in hysterectomy group was（31.0±4.6）and（43.0±8.8）min respectively,with the difference being statistically significant（P〈0.05）.There was no significant difference in average blood loss between SUAE group（2 920±408） mL and hysterectomy group（3 114±327） mL（P〉0.05）.In both two groups,postoperative complications occurred in a small number of patients（P〉0.05）.Conclusion Both hysterectomy and SUAE are effective treatments for severe postpartum hemorrhage.SUAE performed its excellent advantages such as hemostasis quickly,effectively and reliablly,and minimal trauma.What is more,SUAE can reach the purpose of reserving uterus.When the SUAE could not take effect or embolization could not stop the bleeding in time,hysterectomy should be immediately given.