导管动脉栓塞术在难治性产后出血中的应用  

Transcatheter arterial embolization in intractable postpartum hemorrhage

作　　者：陈春林[1] 马奔[1] 方艺川[1] 刘萍[1] 王锦江[1] 张玉洁[1] 何燕[1] 刘佩鸣[1] 

机构地区：[1]广州市第一人民医院妇产科,510180

出　　处：《中华妇产科杂志》2001年第3期133-136,T001,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的　探讨经导管动脉栓塞术 (TAE)在难治性产后出血中的应用价值。方法　以Seldinger技术对 14例难治性产后出血患者 ,行经皮双髂内动脉前干或子宫动脉超选择插管术 ,应用数字减影血管造影 (DSA)技术明确出血部位后灌注抗生素 (头孢噻甲羧肟 ) ,并以明胶海绵颗粒栓塞。结果　 (1) 14例经保守治疗无效的难治性产后出血患者 ,经TAE治疗后一次性止血成功 ,止血时间3～ 10min ,平均时间 (6 1± 3 6 )min ,手术时间 30～ 5 0min ,平均 (4 1 8± 6 4)min ;(2 )应用DSA发现 ,出血均来源于单侧或双侧子宫动脉 ,表现为宫腔内弥漫性、局灶性出血或单侧子宫动脉分支出血 ;(3)随访 2～ 6 0个月 ,14例患者均恢复规律月经 ,无严重并发症发生。结论　应用TAE治疗难治性产后出血有较好的临床效果 ,具有止血快。Objective To assess the value of transcatheter arterial embolization treatment in intractable postpartum hemorrhage. Methods Fourteen patients of postpartum hemorrhage failed to the drugs treatment were performed transcatheter arterial embolization (TAE). Superselective catheterization to the bilateral uterial arteries or anterior branches of internal iliac arteries was carried out after intubation to single side femoral artery by Seldinger′s technique. When the catheter tip was proved in right place by digital substraction angiography (DSA) techniques, antibiotic solution was poured into arteries and then the arterial embolization with gelfoam particles was followed. Results All the patients were performed TAE successfully. The duration of TAE was 30～50 minutes [mean (41 8±6 4) minutes]. Bleeding was found in DSA mostly as diffuse intrauterine flow outward sign from one side or both side of uterial artery branches. After one time of TAE, the vaginal bleeding of all patients was stopped in 3～10 minutes [mean (6 1±3 6) minutes]. The follow up showed that all patients had normal menstrual periods in 2～60 months and no serious complications were found. Conclusion With the characteristic of fast homeostasis and less complications, TAE was proved to be an effective method for intractable postpartum hemorrhage.

关 键 词：栓塞治疗 产后出血 子宫 髂内动脉 吸收性明胶海绵 TAE 

分 类 号：R714.4[医药卫生—妇产科学]