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1.
双侧子宫动脉栓塞术治疗难治性产后出血21例分析   总被引:10,自引:0,他引:10  
目的探讨双侧子宫动脉栓塞术治疗难治性产后出血的疗效及安全性。方法于2003年4月至2005年9月采用Seldinger技术行双侧子宫动脉栓塞术,治疗东莞市厚街医院各种原因导致难治性产后出血21例。其中胎盘早剥合并DIC10例,部分性胎盘植入8例,子宫下段裂伤3例。结果21例患者平均手术时间(40±5)min,栓塞术后平均止血时间(10.0±3.2)min。均抢救成功并保留了子宫,近期无明显并发症。结论双侧子宫动脉栓塞术治疗难治性产后出血具有止血快,且能保留子宫等优点。  相似文献   

2.
选择性子宫动脉栓塞术治疗难治性产后出血13例临床分析   总被引:1,自引:0,他引:1  
目的探讨子宫动脉栓塞术治疗难治性产后出血的时机、疗效及并发症。方法对北京大学人民医院13例难治性产后出血患者,利用数字减影造影(DSA)技术选择子宫动脉及其分支行栓塞治疗。结果 13例产后出血患者分娩时出血量为150~4000ml,平均出血量1200(1200±1215)ml。产后出血总量870~4000ml,平均2555(2555±995)ml。13例患者栓塞前均行按摩子宫,卡孕栓肛塞及欣母沛宫体注射促进子宫收缩,2例剖宫产术中出血患者已行子宫动脉上行支结扎、B-Lynch缝合以及宫腔填纱止血,效果均不佳,经子宫动脉栓塞后12例均成功止血,仅1例未能止血而行全子宫切除术。13例产后出血行子宫动脉栓塞术前存在不同程度的凝血功能异常,在积极纠正凝血功能异常同时行栓塞术。栓塞术后无严重并发症发生,发热为最为常见并发症,但应警惕感染。结论凝血功能障碍并非子宫动脉栓塞术的禁忌证,只要把握好子宫动脉栓塞的时机,子宫动脉栓塞术能有效治疗产后出血,并且并发症少。  相似文献   

3.
急诊动脉栓塞治疗难治性产后出血的临床观察   总被引:2,自引:0,他引:2  
产后大出血是引起产妇死亡的主要原因,以往临床上这类患者经治疗无效时多用外科治疗,但创伤大,并发症发生率高,部分患者因此失去生育能力…。多年以来,我们一直探索既要有效止血,又能保留子宫、维持妇女生殖内分泌功能的方法。2004年始,我院开展了导管动脉栓塞术(TAE),既能达到上述要求,又具有患者创伤小、止血快、子宫和卵巢功能恢复好等优点。现将2004年以来我院采用急诊动脉栓塞术(transcatheterarterialembolization,TAE)抢救9例难治性产后出血患者的结果报告如下。  相似文献   

4.
目的探讨双侧子宫动脉栓塞治疗胎盘早剥并发DIC的可行性和安全性。方法对10例胎盘早剥并发DIC产后出血患者在补充足量凝血因子、抗休克、宫腔塞纱治疗基础上行双侧子宫动脉插管明胶海绵颗粒栓塞。结果10例患者双侧子宫动脉插管均成功,插管成功率100%,平均手术时间(42±5)min,栓塞术平均止血时间(11±3.2)min。10例患者均抢救成功并保留了子宫,无明显近期并发症。结论双侧子宫动脉栓塞治疗胎盘早剥并发DIC产后出血有较好的临床效果,具有止血快,能保留子宫等优点。  相似文献   

5.
动脉栓塞治疗难治性产后出血6例分析   总被引:24,自引:0,他引:24  
目的 :探讨动脉栓塞治疗难治性产后出血的临床价值。方法 :用Seldinger技术对 6例难治性产后出血患者行经皮髂内动脉或子宫动脉超选择插管术 ,通过数字减影血管造影 (DSA)明确盆腔血管走向及造影剂外溢情况后 ,双侧分别注入明胶海绵条栓塞。结果 :6例插管栓塞均 1次成功 ,手术时间短 ,止血速度快 ,并且保留子宫及其生理功能。其中 2例术后再次生育。但 1例术后发生右下肢动脉血栓形成 ,手术取栓后愈合。结论 :动脉栓塞术治疗难治性产后出血快速 ,有效 ,安全 ,并保留了子宫。  相似文献   

6.
经导管动脉栓塞术在难治性产后出血的应用研究   总被引:1,自引:0,他引:1  
产后出血为产科危急重症,是孕产妇重要死因之一,绝大部分产科出血经积极的保守治疗而治愈,但仍有少数难治性病例为挽救生命需行子宫切除术。随着介入放射学在妇产科领域的应用,我们将动脉栓塞术(Transcatheter arterial embohzation TAE)成功的应用于难治性产后出血的治疗,取得较好的临床效果,现报道如下。  相似文献   

7.
介入治疗在重度产后出血中的应用   总被引:55,自引:2,他引:53  
目的探讨介入治疗在重度产后出血中的应用价值。方法三家医院15年间重度产后出血保守治疗无效行次全子宫切除或全子宫切除术47例为手术组,行介入治疗24例为介入组。结果介入组手术时间55.5min,明显短于手术组121.4min(P<0.05);介入组栓塞后止血时间为(5.9±2.6)min;手术组1例行次全子宫切除后复出血转用介入治疗成功止血,余均止血成功。结论介入治疗应用于重度产后出血具有止血快、疗效确切、手术时间短、并发症少的优点。  相似文献   

8.
难治性产后出血干预性治疗方法的对比研究   总被引:104,自引:0,他引:104  
目的探讨难治性产后出血的各种干预性措施在抢救过程中的合理应用及应用价值。方法分析1998年1月至2003年8月间,采用宫腔填塞纱布(塞纱)、盆腔动脉结扎、经导管动脉栓塞术等干预性措施的88例难治性产后出血病人的临床资料。结果全部抢救成功,其中18例宫腔塞纱者成功12例(66.7%),12例盆腔动脉结扎中成功4例(33.3%),30例经导管动脉栓塞术(TAE)治疗全部成功(100%),42例一次开腹行全子宫切除术或加盆腔塞纱者成功36例(85.7%)。结论宫腔塞纱可压迫止血。TAE可替代子宫切除术。当子宫成为凝血功能障碍的病因时,主张行子宫切除.  相似文献   

9.
对重度产后出血介入治疗安全性的评估   总被引:20,自引:0,他引:20  
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。 结论 重度产后出血行介入治疗是安全的  相似文献   

10.
髂内动脉栓塞治疗难治性晚期产后出血17例   总被引:9,自引:0,他引:9  
目的介绍髂内动脉栓塞治疗难治性晚期产后出血的经验.方法采用右股动脉seldinger's穿刺技术,选择性插管至双侧髂内动脉,经导管注入明胶海绵颗粒栓塞双侧髂内动脉.结果晚期产后出血17例,其中剖宫产术后13例,阴道分娩后4例,经栓塞后立即止血.结论髂内动脉栓塞治疗晚期产后出血具有快速、安全、有效,能保留子宫,维持患者正常生育及内分泌功能等优点.  相似文献   

11.
OBJECTIVES: The study was conducted to evaluate the efficacy of superselective transcatheter uterine artery embolization for control of obstetric hemorrhage. METHODS: Between January 2002 and December 2005, 14 consecutive patients underwent uterine artery embolization to control postpartum hemorrhage, and two to prevent hemorrhage before second-trimester therapeutic abortion. RESULTS: Embolization was performed by transfemoral arterial catheterization. Pieces of absorbable gelatin sponge were used in all cases, with the addition of platinum coils in two cases for complete vessel occlusion. Optimal bleeding control was achieved in all cases but one--a patient who underwent hysterectomy due to embolization failure. No severe complications were observed. CONCLUSIONS: The high success rate, low morbidity rate, and possibility of preserving reproductive function have made superselective uterine artery embolization the technique of choice to control life-threatening, intractable postpartum hemorrhage in hemodynamically stable patients, provided multidisciplinary medical teams are promptly available.  相似文献   

12.
Six patients were treated with transcatheter arterial embolization (TAE). Three patients suffered from intractable genital bleeding; the other three patients were preoperative cases of a stage III adenocarcinoma of the uterine cervix and two of these had gestational trophoblastic disease. Bleeding was stopped in all three cases of intractable hemorrhage; one patient rebled after 6 days. In the three preoperative cases, transcatheter arterial embolization was thought to be effective in decreasing intraoperative blood loss. There are no other reports of application of this technique to preoperative cases to decrease intraoperative blood loss in gynecological cases.  相似文献   

13.
Four of 1237 patients who underwent abdominal, laparoscopic, and vaginal hysterectomy between October 2013 and May 2015 had severe secondary hemorrhage after hysterectomy (2 conventional multiport total laparoscopic hysterectomies, 1 single-port access hysterectomy, and 1 total abdominal hysterectomy). The median time interval between hysterectomy and secondary hemorrhage was 28.4 days (range, 16–52 days). All 4 cases were treated with transcatheter arterial embolization (TAE), all of whom required blood transfusions to maintain vital functions before TAE. The mean operative time was 90 minutes. The median length of hospital stay after TAE was 12 days (range, 4–24 days), and the patients were discharged without complications or additional surgery. These cases show the value of minimally invasive TAE for patients experiencing severe secondary hemorrhage after hysterectomy.  相似文献   

14.
Two cases of intractable postpartum hemorrhage could be controlled by Gelfoam embolization via an angiographic catheter. The data presented here indicate that transcatheter embolization for postpartum hemorrhage is a safe and effective method compared to surgical ligation of the injured artery.  相似文献   

15.
Objective: Obstetric hemorrhage is a significant cause of maternal morbidity and death. Postpartum hemorrhage that cannot be controlled by local measures has traditionally been managed by bilateral uterine artery or hypogastric artery ligation. These techniques have a high failure rate, often resulting in hysterectomy. In contrast, endovascular embolization techniques have a success rate of >90%. An additional benefit of the latter procedure is that fertility is maintained. We report our experience at Stanford University Medical Center in which this technique was used in 6 cases within the past 5 years. Study Design: Six women between the ages of 18 and 41 years underwent placement of arterial catheters for emergency (n = 3) or prophylactic (n = 3) control of postpartum bleeding. Specific diagnoses included cervical pregnancy (n = 1), uterine atony (n = 3), and placenta previa and accreta (n = 2). Results: Control of severe or anticipated postpartum hemorrhage was obtained with transcatheter embolization in 4 patients. A fifth patient had balloon occlusion of the uterine artery performed prophylactically, but embolization was not necessary. In a sixth case, bleeding could not be controlled in time, and hysterectomy was performed. The only complication observed with this technique was postpartum fever in 1 patient, which was treated with antibiotics and resolved within 7 days. Conclusions: Uterine artery embolization is a superior first-line alternative to surgery for control of obstetric hemorrhage. Use of transcatheter occlusion balloons before embolization allows timely control of bleeding and permits complete embolization of the uterine arteries and hemostasis. Given the improved ultrasonography techniques, diagnosis of some potential high-risk conditions for postpartum hemorrhage, such as placenta previa or accreta, can be made prenatally. The patient can then be prepared with prophylactic placement of arterial catheters, and rapid occlusion of these vessels can be achieved if necessary. (Am J Obstet Gynecol 1999;180:1454-60.)  相似文献   

16.
Fourteen patients with intractable bleeding of obstetric or gynecological origin underwent transcatheter angiographic arterial embolization. Three patients had postpartum hemorrhage associated with dilutional coagulopathy, anticoagulant therapy and placental leukemic metastases, or placenta percreta. One patient had locally advanced gestational trophoblastic tumor, one had uterine sarcoma and 8 had advanced cervical malignancy. Bleeding was completely controlled in all patients regardless of the initiating event. The embolizing material was gelatin sponge particles in 12 patients, and spring coil in 2. In experienced hands, angiographic arterial embolization is a safe, effective and less invasive alternative to surgical ligation in some clinical states of pelvic female genital tract hemorrhage.  相似文献   

17.
Six patients with uncontrollable postpartum hemorrhage due to genital tract injury were treated with transcatheter arterial embolization. The causes of hemorrhage were laceration of the cervix and vagina in five cases and rupture of the uterus in one. Four cases included a large hematoma in the paravaginal and/or retroperitoneal space. Two women had a hysterectomy before arterial embolization. Angiography revealed extravasation in five cases. All six subjects had their hemorrhage arrested dramatically using transcatheter arterial embolization with gelatin sponge particles. No major complication was encountered in any case. Normal menstruation resumed in the women who did not undergo a hysterectomy. Transcatheter arterial embolization therapy seems to be the treatment of choice in patients with uncontrollable hemorrhage.  相似文献   

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