子宫动脉栓塞术在难治性产后出血中的应用

Application of Uterine Arterial Embolization in Intractable Postpartum Hemorrhage

目的通过对难治性产后出血治疗过程中进行动脉栓塞术和子宫切除术的临床特点的分析,探讨子宫动脉栓塞术的临床应用价值。方法回顾性分析、收治孕产妇15 252例中41例难治性产后出血患者的临床资料,经保守治疗无效行次全子宫切除术或全子宫切除术20例为手术组,行子宫动脉栓塞治疗21例为栓塞组。结果栓塞组短于子宫切除组,差异有统计学意义(P<0.05),21例患者采用双侧子宫动脉栓塞术止血均获得成功,其中2例胎盘植入进行治疗及预防性栓塞,分别在术后8 d,5个月钳夹胎盘,术中出血少,均成功治愈。结论栓塞术具有手术时间短、止血效果好,术后住院天数短、并发症少,可保留子宫和生育功能,可有效降低子宫切除率,但无法取代子宫切除。

Objective To analyze the clinical features of arterial embolization and hysterectomy for intractable postpartum hemorrhage during the treatment, to explore the clinical value of uterine artery embolization. Methods A retrospective analysis of 15 252 cases of pregnant women were treated, 41 cases clinical data of patients with refractory postpartum hemorrhage, conservative treatment is invalid for hysterectomy or hysterectomy for 20 cases of operation group, underwent uterine artery embolization in the treatment of 21 cases of embolization group. Results The embolization group was significantly shorter than the hysterectomy group, the difference was statistically significant（P〈0.05）, 4.21 cases weretreated with bilateral uterine artery embolization were successful,2 cases of placenta implantation for the treatment and prevention of embolism, respectively in 8D after operation,5 months to clamp the placenta, less bleeding, were cured. Conclusion Embolization with shorter operation time, good hemostatic effect, postoperative hospitalization time is short, less complications, and can preserve the uterus and fertility, can effectively reduce the rate of hysterectomy, but cannot replace hysterectomy.