子宫动脉化疗栓塞缓解中晚期妊娠合并前置胎盘引产术出血的临床应用  

Uterine arterial chemoembolization for the treatment of hemorrhage caused by induced labor for advanced stage of pregnancy complicated by placenta previa: its clinical application

作　　者：王亚勋[1,2] 赵松[1] 祝新平 龙清云[1] 张晓龙[1] 张一帆[1] 

机构地区：[1]武汉大学中南医院放射科,430071 [2]武汉大学基础医学院 [3]孝感市第一人民医院

出　　处：《介入放射学杂志》2013年第2期113-116,共4页Journal of Interventional Radiology

摘　　要：目的探讨子宫动脉化疗栓塞预防和治疗中晚期前置胎盘引产术中大出血。方法 2008年2月至2012年2月收治32例妊娠中晚期合并前置胎盘需终止妊娠者,按引产方式分为对照组14例(利凡诺羊膜腔注射引产)和介入组18例(选择性双侧子宫动脉化疗栓塞术联合依沙吖啶(利凡诺)羊膜腔注射引产),术后24 h应用低分子右旋糖酐、复方丹参促进子宫侧支循环建立。比较两组产后出血率和输血率。结果对照组产后大出血7例,输血7例,其中有3例采用选择性双侧子宫动脉栓塞术,1例行子宫切除术,平均出血量为(930±163)ml;介入组均未发生大出血,平均出血量为(228±20)ml,无输血及子宫切除病例,两组间差异有统计学意义(P<0.05)。结论选择性子宫动脉化疗栓塞术可以有效预防和治疗中晚期妊娠因合并前置胎盘引产而引起的产道大出血。Objective To evaluate the uterine arterial chemoembolization in protecting against and treating the massive bleeding occurred after the induction of labor for advanced stage of pregnancy complicated by placenta previa. Methods During the period from Feb. 2008 to Feb. 2012 a total of 32 patients with advanced stage of pregnancy complicated by placenta previa were admitted to authors＇ hospital. According to the type of induced labor, the patients were divided into control group （n = 14） and intervention group （n = 18）. The induction of labor by using the intra- amniotic injection of ethacridine lactate was performed in the patients of the control group, while the induction of labor by using selective bilateral uterine arterial chemoembolization combined with intra-amniotic injection of ethacridine lactate was carried out in the patients of the intervention group. Low molecular dextran and compound radix salviae mihiorrhizae were employed 24 hours after the treatment in order to promote the formation of uterine collateral circulation. The postpartum hemorrhage rate and blood transfusion rate were recorded, and the results were compared between the two groups. Results In the control group, the postpartum massive bleeding occurred in 7 patients. Blood transfusion was employed in 7 patients, of whom selective bilateral uterine artery embolization was employed in 3. Hysterectomy had to be carried out in one patient. The mean blood loss was （930 ± 163） ml. In intervention group no postpartum massive bleeding occurred and the mean blood loss was only （228 ± 20） ml. Neither blood transfusion nor hysterectomy was needed. The differences between the two groups were statistically significant （P 〈 0.05）. Conclusion Selective uterine arterial chemoembolization is an effective method to protect against and treat the massive bleeding occurred after the induction of labor for advanced stage of pregnancy complicated by placenta previa.

关 键 词：前置胎盘 子宫动脉化疗栓塞术 引产 

分 类 号：R719[医药卫生—妇产科学]