晚期产后大出血的血管内栓塞治疗  

Transcatheter arterial embolization for treatment of intractable late postpartum hemorrhage

作　　者：郝丽霞[1] 张强[2] 高毅[2] 游国超[2] 

机构地区：[1]河南省濮阳市安阳地区医院妇产科,455000 [2]河南省濮阳市安阳地区医院介入科,455000

出　　处：《中国实用医刊》2009年第3期36-39,共4页Chinese Journal of Practical Medicine

摘　　要：目的评价经导管动脉栓塞术治疗晚期产后大出血的应用价值。方法17例晚期产后大出血患者（产后9～31d，平均21d），采用右侧股动脉穿刺入路，行盆腔动脉造影确定出血动脉所在，然后超选择进入出血动脉，先灌注抗生素，然后用明胶海绵颗粒栓基出血动脉。若为子宫动脉出血，行双侧子宫动脉栓塞。结果17例患者经动脉栓塞唐止血成功，插管成功率100％，其中子宫动脉出血16例（左侧9例，右侧7例），左侧阴部内动脉出血1例，手术时间25～50min，平均35min，止血时间3～10min。术后患者生命体征逐渐恢复，随访观察，未见有再出血发生，所有患者转经后月经正常，无严重并发症。结论经导管动脉栓塞术治疗晚期难治性产后大出血，疗效快速肯定，创伤小，患者恢复快，有很好的临床应用价值。Objective To evaluate the clinical value of transcatheter arterial embolization for treatment of intractable late postpartum hemorrhage. Methods Seventeen patients with intractable late postpartum hemorrhage were undertaken arterial embolization （9 to 31 days after parturition, average 21 days）. All of the 17 patients were punctured the right femoral artery. Detected the bleeding artery by pelvic artery angiography, then superselectively catheterized into the bleeding artery （uterine artery or the other pelvic artery）, perfused broad -spectrum antibiotic into the bleeding artery first then embolized it with gelfoam particles immersed with broad - spectrum antibiotic. Embolized the bilateral artery when found the bleeding artery was uterine artery. Results The bleeding artery was unilateral uterine artery detected in 16 patients （ left 9, right 7 ）, the other one was the left internal pudendal artery. The catheterization successful rate and the bleeding artery hault rate were 100% respectively. The procedure lasted for 25 -50 rain（ average 35 min）. After the procedure, all of the 17 patients recovered gradually, no recurrent hemorrhage and no serious complications happened, menstruation of all the patients resumed during the follow -up period. Conclusion Transcatheter arterial embolization is a safe and effective way for treatment of intractable late postpartum hemorrhage, with it＇s advantages of mini -invasive, fast treating effect and less complications.

关 键 词：晚期产后出血 动脉栓塞 子宫 明胶海绵 

分 类 号：R714.461[医药卫生—妇产科学] R739.41[医药卫生—临床医学]