35例血管性介入治疗在妇产科大出血中的临床应用

Application of Vascular Intervention in Treatment of Obstetric and Gynecologic Hemorrhage

目的探讨血管性介入治疗用于妇产科大出血的临床价值。方法对保定市第二中心医院2004年9月-2012年5月35例经保守治疗无效的妇产科大出血患者,应用Seldinger’s技术行右侧股动脉穿刺插管,在数字减影血管造影(DSA)的监视下,明确出血部位,以携带有抗生素的明胶海绵颗粒(1～3 mm)对双侧子宫动脉或双侧髂内动脉进行栓塞止血。结果 35例患者均一次性止血成功,且保留了子宫。平均手术时间(49.12±6.9)min。栓塞术后病人仅表现出不同程度的疼痛及发热症状,经对症治疗后缓解,并无严重并发症发生。除一例宫颈癌患者术前已绝经外,其余患者术后月经均恢复正常。结论血管性介入在妇产科大出血的治疗中具有微创、快速、准确、疗效好、最重要的是保留了患者子宫及生育能力等优点,值得在临床推广。

Objective To evaluate the clinical value of the vascular intervention treatment in the obstetric and gynecologic hemorrhage. Methods To select 35 cases of gynecologic hemorrhage failed in conservative treatment in our hospital during the period of September 2004 to May 2012 as samples. The right femoral artery puncture and catheterization was performed by Seldinger interventional radiology. By using digital subtraction angiography, we injected gelfoam particles with antibiotics to get embolism of the bilateral uterine artery or internal itiac artery, which was performed to demonstrate the bleeding sources. Results All 35 patients were cured after one time of arterial embolization and their uterus were reserved. The mean operating time was （49.12 ± 6.9 ） min. The patients represented only slight abdominal pain and fever of different level, and these symptoms were relieved after treatment. No sever complication were observed. And all the cases were returned to normal menstruation after surgery except that one was postmenopausal before surgery. Conclusion In the treatment of obstetric and gynecologic hemor- rhage,vascular intervention has the advantages of minimally invasive, fast, accurate, effective and so on, and one of the most im- portant advantages is the uterus and fertility can be reserved. Therefore,it can be widely used in clinic.