剖宫产后出血原因分析及介入治疗的价值  

The analysis of the causes of uterine bleeding occurred after cesarean section and the evaluation of interventional therapy for bleeding

作　　者：胡鹏[1] 李玉伟[1] 李云辉[1] 罗斌[1] 文雯[1] 杨波[1] 

机构地区：[1]四川泸州医学院附属医院放射科,646000

出　　处：《介入放射学杂志》2011年第8期613-616,共4页Journal of Interventional Radiology

摘　　要：目的分析剖宫产后出血的原因,探讨介入性血管造影及经导管动脉栓塞治疗方法在诊断和治疗剖宫产后出血的临床应用价值。方法 2001年1月至2011年12月对65例剖宫产后出血患者进行子宫动脉造影,并行经导管子宫动脉栓塞术治疗,术后观察止血效果,并对患者的临床及影像学表现进行回顾性分析。结果剖宫产后出血原因系子宫动脉假性动脉瘤者26例,宫缩乏力18例,胎盘因素11例,妊娠高压8例,另有子宫出血合并子宫肌瘤1例及不明原因子宫出血1例。经导管子宫动脉造影时,除1例不明原因出血的患者造影时未见对比剂外溢,其余64例均可见对比剂外溢,诊断子宫动脉出血明确,栓塞治疗后出血均停止、病情稳定,无严重并发症。结论假性动脉瘤的形成是剖宫产后出血的一大主要原因,经导管子宫动脉造影术可以快速地判断出血原因并及时进行栓塞治疗,对剖宫产后大出血的患者具有较好的临床价值。Objective To analyze the causes of uterine hemorrhage occurred after cesarean section and to investigate the value of angiography and transeatheter artery embolization （TAE） in the diagnosis and treatment of postpartum hemorrhage after cesarean section. Methods During the period from Jan. 2001 to Dee. 2011, a total of 65 eases suffering from uterine bleeding after cesarean section had underwent uterine arteriography to clarify the diagnosis, which was followed by transcatheter uterine artery embolization （TUAE）. The clinical data, the causes of bleeding and the angiographic features were retrospectively analyzed. Results The causes of uterine bleeding after caesarean section included uterine artery pseudoaneurysm （n = 26）, uterine atony （n = 18）, placental factors （n = 11）, gestational hypertension （n = 8）, coexisting uterine fibroids （n = 1） and uterine bleeding of unknown reason （n = 1）. Uterine artery angiography revealed contrast extravasation in all patients except one patient. The angiographic findings confirmed the diagnosis of uterine artery bleeding after cesarean section. The bleeding stopped after TUAE, and the patients were in stable condition. No serious complications occurred. Conclusion Pseudoaneurysm is the primary cause of postpartum uterine hemorrhage after cesarean section. Transcatheter uterine artery angiography can promptly and reliably determine the causes of bleeding, and, at the same time, embolization therapy can be carried out to effectively stop the bleeding.

关 键 词：剖宫产 产后出血 血管造影 经导管子宫动脉栓塞术 

分 类 号：R714.462[医药卫生—妇产科学]