超选择性子宫动脉栓塞在植入性胎盘治疗中的初步疗效观察  

Primary observation of clinical curative effect of superselective uterine artery embolization for treatment of placenta increta

作　　者：王长福[1] 张和平[1] 张红霞[1] 靳海英[1] 王斌杰[1] 贺祥[1] 张杰[1] 李长波[1] 

机构地区：[1]河南大学淮河医院放射科,开封475000

出　　处：《中华放射学杂志》2008年第5期512-514,共3页Chinese Journal of Radiology

摘　　要：目的探讨超选择性子宫动脉栓塞（UAE）治疗植入性胎盘的疗效。方法行盆腔动脉造影明确出血血管后，将5 F Cobra导管超选择性插入出血侧子宫动脉，注入甲氨喋呤，而后采用明胶海绵颗粒和明胶海绵条栓塞。术后随访观察出血、血压、胎盘组织排出、子宫复旧和血绒毛膜促性腺激素β亚单位（β—HCG）等情况。结果5例胎盘植入患者均找到出血位置并1次性栓塞成功。手术时间25.0～60．0min，平均为（37.4±5．8）min；急性出血者术后3.0～12．0min阴道大量流血停止，平均为（5．7±2．4）min。患者生命体征平稳，术后血压回升。术后5d至4周排出胎盘组织，平均排出时间为17d，子宫如期复旧，血β-HCG恢复正常，随访月经正常，自测排卵正常。结论UAE治疗植入性胎盘具有手术时间短、创伤小、疗效肯定和可保留子宫等优点，有较好的临床应用价值。Objective To explore the curative effect on superselective uterine artery embolization for treatment of placenta increta. Methods Pelvic arteriography was performed to confirm bleeding vessels. Then a 5 F Cobra catheter was inserted superselectively into uterine artery ipsilateral to bleeding, through which methotrexatum （MTX） and gelatin sponge were injected for embolization. After the procedure, bleeding, blood pressure, dischargement of placenta tissue, uterine recuperation, and plasma β-HCG were monitored. Results Bleeding vessels were confirmed in all of the 5 cases of placenta increta. Uterine artery embolization was successful at sole procedure. The operation time was 25.0 to 60.0 min, with the mean time （37.4 ±5.8） min. Vaginal bleeding stoped in 3. 0 to 12. 0 minutes after embolization and the mean time was （5.7 ± 2.4 ） min. Blood pressure returned to normal after operation and vital signs were stable. Placenta tissue discharged on the 5th day to the 4th week after embolization and the mean time was 17 d. The uterus recuperated and blood β-HCG recovered simutaneously. The menstruation and ovulation during follow-up returned to normal. Conclusion Superselective uterine artery embolization for treatment of placenta increta has advantages such as short operation time, minimal invasion, definite curative effect and reservation of uterus, which is worthy in clinical application.

关 键 词：胎盘 侵入性 栓塞 治疗性 产后出血 

分 类 号：R686[医药卫生—骨科学]