子宫动脉栓塞术后并发血栓的临床病例分析和诊治探讨

Clinical Analysis of the Diagnosis and Treatment of Postoperative Deep Venous Thrombosis after Uterine Artery Embolization Treatment

目的:探讨剖宫产瘢痕妊娠(CSP)患者经子宫动脉栓塞术(UAE)后并发下肢深静脉血栓(DVT)的临床病例的诊断治疗要点。方法:回顾性分析2014年-2016年我院收治的剖宫产瘢痕妊娠患者经子宫动脉栓塞术后并发下肢深静脉血栓(DVT)5例患者的临床特点及诊断、治疗方法。结果:2014年-2016年,我院CSP患者经UAE治疗后发生DVT的发病率为1.63%,患者平均年龄35.2岁。DVT临床症状出现于UAE术后3-6天,多表现为下肢的疼痛及酸胀,深静脉血栓均出现在介入穿刺处肢体。用彩色多普勒血流显像诊断深静脉血栓安全可靠。采用低分子肝素皮下注射抗凝治疗均取得较好效果。结论:剖宫产瘢痕妊娠患者经子宫动脉栓塞术治疗后有发生下肢深静脉血栓风险,DVT发生与穿刺处肢体制动,血管受压,血液回流障碍有关。手术前后应采取预防措施,低分子肝素钠抗凝对DVT治疗有效。

Objective： To describe the clinical profile of deep venous thrombosis（DVT） after uterine artery embolization treatment caesarean scar pregnancy and study how to choose the methods of diagnosis and treatment of DVT. Methods： The clinical characteristics,diagnosis and treatment of 5 cases of patients who were diagnosed as caesarean scar pregnancy（CSP）after uterine artery embolization from 2014 to 2016 in Beijing Obstetrics and Gynecology Hospital were retrospectively analyzed. Results： The incidence of DVT in caesarean scar pregnancy with UAE treatment was 1.63%, the average age of DVT was 35.2 years old. Clinical signs appeared after UAE treatment 3 to 6 days. More performance was pain and acid bilges in the lower limb and all of thrombosis located in the intervention leg.It was safe and reliable to diagnose DVT with color-code Doppler ultrasonography. Low molecule weight heparin anticoagulation was effective in the treatment of postoperative DVT. Conclusion： There was risk to have DVT in caesarean scar pregnancy patients with uterine artery embolization treatment. The occurrence of DVT related to puncture limbs braking, the compression of blood vessels, blood backflow dysfunction. Preventive measures should be taken before and after operation. It was effective to treat DVT with Low molecule weight heparin anticoagulation.