选择性动脉插管栓塞治疗子宫大出血的价值  

The Value of Embolism Through Selective Catheterization of Artery in a Large Amount of Bleeding in Uteri

作　　者：李海平[1] 雷光武[1] 谢江平[1] 李乔秀[1] 翁翎[2] 

机构地区：[1]湖南长沙中南大学湘雅医院放射科,410008 [2]中南大学湘雅医学院临床医学七年制02级

出　　处：《临床放射学杂志》2009年第1期101-103,共3页Journal of Clinical Radiology

摘　　要：目的评价选择性动脉插管栓塞治疗子宫大出血的临床应用价值。资料与方法对64例子宫大出血患者均行双侧髂总动脉数字减影血管造影(DSA)检查,明确出血部位后选择或超选择插管,栓塞子宫动脉或髂内动脉前干,栓塞剂采用明胶海绵、聚乙烯醇(PVA)微粒、弹簧钢圈。结果64例患者行DSA检查时,盆腔区均可见对比剂外溢和聚集,其中36例采用明胶海绵颗粒栓塞子宫动脉或髂内动脉前干后31例止血一次成功,其中5例7～10天再发大出血,行第二次介入栓塞治疗后3例止血成功,仅2例止血效果不佳而行子宫切除术;20例采用PVA微粒和明胶海绵颗粒栓塞以及3例合并有动静脉瘘和2例合并有假性动脉瘤者采用明胶海绵条加弹簧钢圈后止血一次成功;3例采用PVA微粒和明胶海绵颗粒仅栓塞一侧子宫动脉或髂内动脉前干后3～7天再发出血,行第二次介入栓塞对侧子宫动脉或髂内动脉前干止血成功。介入术后随访2～6个月无复发,均有正常月经来潮,无严重并发症发生。结论动脉栓塞治疗子宫大出血安全、止血迅速、微创,绝大多数能避免手术切除子宫。Objective To evaluate the efficacy and safety of selective arterial embolization in the treatment of uteri bleeding. Materials and Methods 64 cases with uterine hemorrhage received DSA on left and right common iliac artery. They were treated by selective or super selective artery embolization of uterine artery or internal iliac artery. Results DSA showed that there were bleeding in all 64 cases. 36 cases were treated by embolization with the gelatin sponge pellet, and this kind of embolization successfully controlled the bleeding in 31 cases. Recurrent hemorrhage occurred in the rest 5 cases in 7- 10 days, and 3 of them were controlled by a second-time embolization, while the other 2 received a hysterectomy. Embolizations with PVA microparticle and gelatin sponge pellet were given to 20 patients and 3 patients complicated with arteriovenous fistula and 2 complicated with false aneurysm also received gelatin sponge pellet combined with coil embolization for one time, 3 patients who were treated by embolization only on one side of the uterine artery showed a recurrent hemorrhage in 3 -7days, and were successfully controlled by a second-time embolization on the other side of the artery. No serious complications and no recurrent bleeding occurred in 2 -6 months. Conclusion Selective arterial embolization is safe and effective method in the treatment of uteri bleeding, most of patients can avoid hysterectomy.

关 键 词：子宫大出血 动脉栓塞 放射学 介入性 

分 类 号：R71[医药卫生—妇产科学]