盆腔动脉栓塞术治疗难治性产后出血的临床研究  

Clinical study of pelvic arterial embolization in the treatment of refractory postpartum hemorrhage

作　　者：赵亮 孙丽芳[1] 郑秀丽[1] 刘静芳[1] 郑蓉[1] 吕青青 张晗 ZHAO Liang;SUN Lifang;ZHENG Xiuli;LIU Jingfang;ZHENG Rong;LYU Qingqing(Department of Obstetrics and Gynecology,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院妇产科,北京100035

出　　处：《中国生育健康杂志》2018年第6期519-523,532,共6页Chinese Journal of Reproductive Health

摘　　要：目的探讨难治性产后出血的临床特点及盆腔动脉栓塞术(PAE)治疗该疾病的有效性及安全性。方法收集北京市积水潭医院2014年1月至2017年12月收治的难治性产后出血患者临床资料,共19例,患者平均年龄(30. 9±4. 5)岁,平均孕周(38. 0±2. 0)周。按照患者分娩情况分为两组,其中自然分娩组7例,剖宫产组12例,比较两组患者难治性产后出血原因、干预措施、出血情况、PAE效果和并发症,分析PAE临床应用效果和价值。结果 19例患者难治性产后出血的原因中,软产道损伤为4例,动静脉瘘4例,子宫乏力因素6例,胎盘因素5例。分娩方式对难治性产后出血发病无影响,自然分娩组患者输注红细胞数量大于剖宫产组,组间差异有统计学意义。所有难治性产后出血患者均应用促宫缩药物,9例患者在PAE前进行了手术干预。19例患者共栓塞了36根动脉,主要是PAE双侧子宫动脉,19例患者均保留子宫,均恢复规律月经。8例患者PAE后出现发热。结论 PAE用于治疗难治性产后出血疗效确切、微创安全,是保守治疗后的一线治疗方案。Objective To explore the clinical features of intractable postpartum hemorrhage,and the efficacy and safety of pelvic artery embolization(PAE)in the treatment of that disease.Methods A total of 19 intractable postpartum hemorrhage patients from Beijing Jishuitan Hospital were included in the study.We collected their clinical data from January 2014 to December 2017.The average age of patients was(30.9±4.5)years,and the average gestational age was(38±2.0)weeks.The participants were divided into two groups according to the mode of delivery,including 7 cases in the vaginal delivery group and 12 cases in the cesarean section group,respectively.We compared the causes,interventions,bleeding,PAE effects and complications of intractable postpartum hemorrhage between the two groups,and analyzed the clinical application and value of PAE.Results Of the 19 patients with intractable postpartum hemorrhage,4 had soft birth canal injury,4 had arteriovenous fistula,6 had uterine fatigue,and 5 had placental factors,respectively.The mode of delivery had no effect on the occurence of intractable postpartum hemorrhage.The number of red blood cells transfused in the vaginal delivery group was greater than that in the cesarean section.All patients with refractory postpartum hemorrhage were treated with uterine contractions,and 9 patients underwent surgical intervention before PAE.19 patients were embolized with 36 vessels,most of whom were PAE bilateral uterine arteries.19 patients retained the uterus and recovered regular menstruation.8 patients developed fever after PAE.Conclusion PAE is effective and safely invasive for the treatment of intractable postpartum hemorrhage.It is the first-line treatment after conservative treatment.

关 键 词：难治性产后出血 盆腔动脉栓塞 治疗 安全性 临床研究 

分 类 号：R714.461[医药卫生—妇产科学]