对重度产后出血介入治疗安全性的评估  

Assessment of the Safety of Invasive Treatment in Severe Postpartum Hemorrhage

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

机构地区：[1]广州市第一人民医院妇产科妇产医学介入诊疗中心,510180

出　　处：《中华围产医学杂志》2002年第3期186-189,共4页Chinese Journal of Perinatal Medicine

摘　　要：目的　评估重度产后出血介入治疗的安全性。　方法　对 18例经保守治疗无效的重度产后出血患者行介入治疗 (经皮双髂内动脉或子宫动脉栓塞术 ) ,从手术时间、治疗效果、侧支循环的建立、栓塞术后宫体肌层病理变化及术中卵巢 X线负荷量等的角度 ,探讨重度产后出血介入治疗的安全性。　结果　 (1) 18例患者均一次止血成功 ,止血时间 3～ 10 m in,平均时间 (6± 4) m in,手术时间 30～ 5 0 min,平均 (39± 5 ) min;(2 )介入治疗后虽然栓塞了双髂内动脉或子宫动脉 ,但仍有卵巢动脉、腹壁下动脉等向子宫供应少量的血流 ;(3) 3例患者于术后 5～ 10 d行宫体穿刺活检 ,病理显示 :子宫体肌层呈散在的、非连续性凝固性坏死 ,范围不超过肌层的 1/4 ,临床未见术后子宫坏死的病例 ;(4 )监测 5例患者术中卵巢所受 X线辐射量为 (17± 7) c Gy,在正常允许耐受量范围内。Objective To assess the safety of emergent invasive treatment in severe postpartum hemorrhage. Methods Invasive treatment was performed in 18 patients with severe postpartum hemorrhage. The operation time, therapeutic effect, collateral circulation of uterus feeding arteries, pathological changes in uterine muscle after embolization and radiation dose received by the ovary during operation were investigated for safety assessment. Results (1) All eighteen patients who had been failed to conservative treatment were successfully cured with invasive treatment. The duration of hemostasis was 3 to 10 minutes, mean time (6±4) minutes. The operation time was 30 to 50 minutes, mean time (39±5) minutes. (2) Although both sides of internal iliac arteries or uterine arteries were embolized, a small amount of blood supply for uterus remains from ovary arteries, from branches external iliac arteries and from other arteries. (3) Uterine biopsies were performed in 3 patients 5 to 10 days after the invasive treatments for pathological examinations. Pathological findings showed that the necroses of uterine muscles were disconnected and the whole areas were blow 1/4. (4) The mean radiation dose received by the ovary in 5 cases was (17±7) cGy, which was within the safe limit. Conclusions The use of the emergency invasive treatment is safe in severe postpartum hemorrhage.

关 键 词：产后出血 介入治疗 安全性 辐射剂量 

分 类 号：R714.4[医药卫生—妇产科学]