难治性妇科大出血的数字减影血管造影术(DSA)诊断和介入栓塞治疗的应用价值  

The DSA diagnosis and interventional embolism therapy for refractory gynecological massive hemorrhage

作　　者：潘少咏[1] 李廉[1] 王利民[1] 

机构地区：[1]南宁市第一人民医院介入放射科,530022

出　　处：《中国临床新医学》2010年第1期58-60,共3页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

摘　　要：目的探讨难治性妇科大出血的数字减影血管造影术(DSA)诊断和介入栓塞治疗的临床应用价值。方法对10例难治性妇科大出血患者采用Seldinger技术行急诊双侧髂内动脉DSA造影,根据髂内动脉造影结果和患者的具体情况决定是否进行超选择性子宫动脉造影,所有患者均用明胶海绵栓塞出血侧髂内动脉或双侧子宫动脉。结果7例髂内动脉造影动脉期见造影剂外渗并聚集于子宫体旁;3例双侧髂内动脉造影未见造影剂明显外渗而行双侧子宫动脉造影,其中2例右侧子宫动脉升支见造影剂外渗、聚集,1例宫底偏左侧造影剂外渗,双侧子宫动脉明显增粗。10例出血患者都采用明胶海绵栓塞,其中1例未能止血,后转上级医院治疗发现该患者患有"血友病",1例刮宫术后大出血患者栓塞后出血停止,但过早取出阴道内填塞止血纱布条时再出血转手术治疗,发现子宫底部有一3cm裂口。其余患者栓塞后出血立即停止,血压恢复正常,观察1周无再出血后出院。结论DSA能定位诊断妇科大出血,介入栓塞治疗难治性妇科出血安全、有效。Objective To discuss the clinical application value of DSA dignosis and interventionnal embolism therapy for refactory gynecological massive hemorrhage. Methods The emergency treatment of double arteriae hypogastrica＇s DSA visualization with seldinger technoligy were carried out in 10 cases of refractory gynecological massvie hemorrhage. On the basis of particular situation it was decided whether super-selectivity arteriae uterine visualization should be caried out; all patients were used gelfoma sponge to embolize hemorrhagic arteriae hapogasstrica or double arteriae hypogastrica or double arteriae uterine. Results It was found that the contrast medium was exuded and gathered uterus in 7cases of arteriae hypogastrica visualization. The constrast medium was not obviously exuded in 3 cases of double arteriae hypogastrica visualization, and double arteriae uterine visualization were caried out,in 2 cases amang them,the contrast medium was exuded and gathered at the anacrotic limb of right arteriae uterine,in 1 case ,the contrast medium was exuded at the fight fundus uteri ,the double artriae uterine was obviously thickened. The 10 hemorrhage patients were all used gelfoam sponge for embolism. In 1 case among them can not stopped hemorrhage, after transferred to superior hospital for treatment,it was found that the patient suffered haemophilia. In 1 pa- tient underwent cesarean section, after embolism the hemorrhage was reduced,but can not be stopped completely, after transferred for surgical operation treatment, a 3 cm split was found at the fundus uteri. After embolism, other patients＇s hemorrhage was stopped immediately, blood pressure recovered normally. After one week of observation no hemorrhage occurred again, all patients discharged from hopital. Conclusion DSA can locate and diagnose the gynecological massive hemorrhage, treating the refrectory gynecological massive hemorrhage with interventional embolism is safe and effective.

关 键 词：妇科出血 栓塞 介入治疗 

分 类 号：R713[医药卫生—妇产科学]