子宫动脉介入栓塞术在严重产后出血治疗中的应用价值

Application value of uterine artery interventional embolization in treating severe postpartum hemorrhage

目的对比分析子宫动脉介入栓塞术、盆腔子宫动脉结扎术、宫腔纱条填塞术3种不同手术方法在严重产后出血治疗中的应用效果。方法选取2010年3月至2016年3月该院收治的60例严重产后出血患者作为研究对象,分为A组、B组和C组,每组20例。A组采用子宫动脉介入栓塞术,B组采用盆腔子宫动脉结扎术,C组实施宫腔纱条填塞术。分别比较三组患者手术指标(术中出血量、产后出血量、止血时间及手术时间),手术效果(止血成功率、子宫切除率及术后转重症监护病房比例),激素水平(血清尿促卵泡素、黄体生成激素及血清雌二醇),卵巢动脉阻力指数(RI)及搏动指数(PI)的差异。同时对三组患者随访12个月,比较三组患者生活质量的差异。结果 A组患者手术指标、手术效果均明显优于B、C组,差异均有统计学意义(P<0.05);三组患者激素水平、卵巢动脉RI及PI、生活质量评分比较,差异均无统计学意义(P>0.05)。结论子宫动脉介入栓塞术治疗在不影响患者产后月经及激素水平情况下治疗严重产后出血的疗效显著,且患者术后恢复较快,因而值得推广应用。

Objective To comparatively analyze the application effect of three different methods of uterine artery interventional embolization,pelvic and uterine artery ligation and intrauterine gauze packing in the treatment of severe postpartum hemorrhage. Methods Sixty cases of severe postpartum hemorrhage in this hospital from March 2010 to March 2016 were selected as the research subjects and divided into the group A（n =20）,B（n =20） and C（n =20）.The group A adopted the uterine artery embolization,the group B adopted the pelvic and uterine artery ligation and the group C was implemented the intrauterine gauze packing. The operation indicators（intraoperative blood loss volume,postpartum hemorrhage volume,hemostasis time and operation time）,operation effect（hemostasis success rate,uterine resection rate and proportion of postoperatively converting to ICU）,hormone levels（serum follicle-stimulating hormone,luteinizing hormone,estradiol）,ovarian artery resistance index（RI） and pulse index（PI） were compared among 3 groups. Meanwhile the three groups were followed up for 12 months,and the differences in the quality of life were compared among the three groups. Results The operation indicators and operation effect in the group A all were better than those in the group B and C, the difference was statistically significant（P〈0.05）;the hormone levels,ovarian artery RI and PI and living quality score had no statistical difference among 3 groups（P〈0.05）. Conclusion The uterine artery interventional embolization can play a significant effect in the treatment of severe postpartum hemorrhage without affecting postpartum menstruation and hormone level,moreover postoperative recovery is faster,so it is worthy of popularization and application.