子宫动脉结扎与盆腔动脉栓塞治疗难治性产后出血的效果研究

Effect of uterine artery ligation and pelvic artery embolization on intractable postpartum hemorrhage

目的探讨子宫动脉结扎与盆腔动脉栓塞（PAE）在难治性产后出血中应用效果。方法收集北京积水潭医院2014年1月至2017年5月期间因难治性产后出血接受子宫动脉结扎和PAE临床资料34例。对出血原因、术中术后情况及治疗结果分析。结果①分娩方式：子宫动脉结扎组均剖宫产分娩，19例PAE中，7例阴道分娩，12例剖宫产；②术前及总出血量：子宫动脉结扎组术前平均出血量、总平均出血量均小于PAE，差异有统计学意义（1522vs1951ml，P〈0．05；1746vs2437ml，P〈0．05）。子宫动脉结扎输注红细胞悬液量和血浆量明显少于PAE组，差异有统计学意义（2．0vs5．1U，P〈0．05；1-0Ⅶ4．0U，P〈0．05）；③出血原因：34例难治性产后出血原因中，胎盘因素居首位，其次是子宫收缩乏力，软产道因素；④术前干预措施：子宫动脉结扎术前无手术干预。PAE前有手术干预，包括：宫腔填塞、球囊压迫、血肿清除；⑤止血成功率及预后：子宫动脉结扎与PAE均有效止血，保留了子宫。止血成功率两组间比较差异无统计学意义（P〉0．05）。月经恢复时间在两组间比较，差异无统计学意义（P〉0．05）。结论子宫动脉结扎与PAE对于难治性产后出血均有良好的止血效果，PAE具有手术时间短、术中出血少的优势，难治性产后出血产妇应根据具体情况选择合适止血方式。

Objective To investigate the effect of uterine artery ligation and pelvic artery embolization （PAE） in intractable postpartum hemorrhage. Methods From January 2014 to May 2017, 34 cases of uterine artery ligation and PAE due to intractable postpartum hemorrhage were collected from Beijing Jishuitan Hospital. Causes of bleeding, intraoperative and postoperative conditions and treatment results were analyzed. Results ①Mode of delivery： Uterine artery ligation group all cesarean delivery; in rases of PAE 19, 7 cases vaginal delivery, 12 cases cesarean section; ② Preoperative and total blood 10SS： the preoperative average＇blood loss and total average blood loss of uterine artery ligation group were both lower than PAE, the difference was statistically significant （1 522 vs 1 951 ml, P〈0.05; 1 746 vs 2 437 ml, P〈0.05）. The transfusion volume of erythrocyte suspension and plasma volume in the uterine artery ligation group were significantly less than PAE group, the difference was statistically significant （2.0 vs 5.1 U, P〈0.05; 1.0 vs 4.0 U, P 〈 0.05）. ③ Causes of bleeding： In 34 cases of intractable postpartum hemorrhage, placenta ranked first, followed by uterine atony and soft birth canal; ④ Preoperative interventions： No surgical intervention before uterine artery ligation. Surgical interventions before PAE include： intrauterine packing, balloon compression, vaginal hematoma clearance. ⑤Hemostatic success rate and prognosis： Uterine artery ligation and PAE are effective to stop bleeding and retain the uterus, with no statistically difference （P〉0.05）. Menstruation recovery time was no significant difference between the two groups （P〉0.05）. Conclusions Uterine artery ligation and PAE have a good effect on intractable postpartum hemorrhage. PAE has the advantages of shorter operation time and less intraoperative bleeding. Doctors should choose the appropriate hemostasis method according to the specific circtmastances.