介入栓塞在剖宫产后子宫瘢痕妊娠大出血中的临床应用  

APPLICATION OF INTERVENTIONAL EMBOLIZATION IN THE TREATMENT OF MASSIVE HEMORRHAGE IN CESAREAN SCAR PREGNANCY

作　　者：张佩玲[1] 罗淑贞[1] 

机构地区：[1]广州市花都区人民医院,广东广州510800

出　　处：《现代医院》2015年第9期48-50,共3页Modern Hospitals

摘　　要：目的探讨介入栓塞在急诊救治剖宫产后子宫瘢痕妊娠大出血中的作用及应用价值。方法我院2010年1月～2014年6月收治了10例剖宫产后子宫瘢痕妊娠大出血患者，出血量在1620—3260mL，经止血剂、宫缩剂、输血、输液、堵塞纱条等治疗无效后行双侧子宫动脉超选择性插管，注入甲氨蝶呤（MTX）和明胶海绵颗粒栓塞治疗。结果介入栓塞治疗后，所有患者均在6h内止血，平均出血停止时间（3．9±1．2）h；随访3～6个月，平均（4．6±1．4）个月，无发生再次大出血。所有患者介入栓塞后均有程度不同的恶心、腹胀、腹痛症状，7例伴轻中度发热，给予对症处理症状消失，1例休克患者术后出现轻度肝肾功能损害，经保肾保肝治疗好转后出院，无严重并发症。结论对于剖宫产后子宫瘢痕妊娠大出血患者在常规止血、宫腔纱条填塞无效时可行急诊介入检塞治疗，可控制出血，避免子宫切除。Objective To investigate the effects and application value of interventional embalization in emer- gency treatment.of massive hemorrhage in cesarean scar pregnancy. Methods 10 patients with massive hemorrhage in cesarean scar pregnancy admitted in our hospital from January 2010 to June 2014 with bleeding volume between 1 620 mL and 3 260 mL were given bilateral uterine artery super selective catheterization and injection of methotrexate （MTX） and gelatin sponge particulate embolization therapy after the ineffective treatment of hemostatic agent, tocolyt- ic agents, blood transfusion, infusion and gauze packing. Results After interventional treatment, all patients stopped bleeding within 6h with the average stop time of （ 3.9 ±1.2） h; 3 - 6 months of follow - up visit with the av- erage of （4.6 ±1.4） months showed no recurrence of massive hemorrhage. After interventional embolization, all pa- tients indicated various degrees of nausea, abdominal distension and abdominal pain, with 7 patients with mild to moderate fever which relieved after given symptomatic treatment and 1 patient with shock who experienced mild dam- age to liver and kidney function after operation and discharged after the treatment of kidney and liver protective thera- py with no serious complications. Conclusion For patients with massive hemorrhage in cesarean scar pregnancy, e- mergent interventional embolization can be performed to control bleeding and avoid hysterectomy when routine hemo- stasis or gauze packing is invalid.

关 键 词：介入栓塞 剖宫产后瘢痕妊娠 大出血 急诊 应用 

分 类 号：R581.1[医药卫生—内分泌]