妊娠有关出血介入栓塞治疗的临床应用

The clinical application of interventional embolization in pregnancy related bleeding

目的评价介入栓塞治疗对胎盘植入、疤痕子宫妊娠、引产、顺产、剖宫产、前置胎盘妊娠等相关妊娠预防和治疗出血的效果及应用价值。方法对2010年1月—2013年12月以来宿州市立医院收治103例妊娠有关出血,19例胎盘植入,6例疤痕子宫妊娠,6例引产后出血,17例顺产后出血,5例前置胎盘妊娠,50例剖宫产后出血患者。采用seldinger技术超选择子宫动脉栓塞,用明胶海绵颗粒及明胶海绵小条在庆大盐水输送下,缓慢注入子宫动脉,以子宫动脉远段及分支血流消失作为栓塞目的。应用于清宫或产后出血。结果 79例出血患者,77例介入治疗后止血效果理想,止血率97.46%,2例止血失败,术后仍出血行子宫切除,24例预防性栓塞,1周内清宫,出血量40～100 ml不等,平均70 ml,除子宫切除者,其他患者没有出现较为严重合并症。患者出院后随访,除子宫切除病例,其他患者月经均在2月内复潮,周期月与经量与以前相比变化不明显。结论介入栓塞术对患者起效迅速,创伤小,并发症少,术后恢复较快,能保留女性子宫,维持女性正常生理功能,特别是要求再次生育的年轻女性,对女性心理能起到极大安慰,是对保守治疗无效的患者极好的治疗方法。

Objective To evaluate the interventional embolization of placenta implantation,uterine scar pregnancy,placenta previa,pregnancy,induced labor,natural birth and cesarean delivery pregnancy prevention and the effect and application value of treatment of hemorrhage. Methods From January 2010 to December 2013,in our hospital,among 103 cases of pregnancy associated haemorrhage： 19 cases of placenta increta,6 cases of uterine scar pregnancy,6 cases of bleeding after induced labor,17 cases of bleeding after natural birth,5 cases of placenta previa during pregnancy,50 cases of hemorrhage after cesarean section. Using seldinger technique choice uterine artery embolization with gelfoam particles and gelfoam small under the big celebration of brine transportation,slowly into the uterine artery,with far branch blood flow and disappeared as uterine artery embolism. Results 79 patients with hemorrhage,77 cases of interventional treatment,the hemostatic effect was ideal,with the bleeding rate of 97. 46%,2 cases of hemostatic failure,with postoperative hemorrhage,cesarean section was performed,24 cases of preventive embolism,1 weeks,the bleeding of 40- 100 ml,70 ml,average unless than hysterectomy,other patients with no serious complications. Patients were followed-up after discharge,in addition to hysterectomy cases,other patients had menstruation in 2 months,cycle month and the quantity did not change significantly than ever before. Conclusion Interventional embolization was quickly,with small trauma,fewer complications and rapid recovery,which can retain female uterus,maintain normal physiological functions of female and fertility of young women,in particular,which can play a great comfort to women psychology,was excellent for invalid conservative treatment patients.