中晚期宫颈癌阴道大出血的急救探讨

目的 研究中晚期宫颈癌阴道大出血的临床特点、急救处理及疗效。方法 分析了23例中晚期宫颈癌阴道大出血的临床资料。经过妇科检查和组织活检诊断宫颈癌。结果 中晚期宫颈癌急性阴道出血多有明显诱因；16例行阴道填塞后血止，余因填塞效果差，有2例行髂内动脉结扎术，2例行腔内后装放疗，3例行髂内动脉栓塞术，以髂内动脉栓塞术止血效果最好。积极止血同时，需行抗休克、应用止血药及抗生素治疗。结论 应减少中晚期宫颈癌阴道大出血的诱因，如避免粗暴妇科检查等；传统的阴道填塞仍是治疗宫颈癌阴道大出血简单有效的方法；髂内动脉栓塞术对难以控制的宫颈癌阴道大出血有重要的治疗价值。

Clinical characteristics and management of patients with middle or later stage cervical carcinoma with severe vaginal hemorrhage

Objective To investigate the clinical feature,treatment options and curative effect of patients with middle or later stage cervical carcinoma with severe vaginal hemorrhage.Methods 23 patients with severe vaginal bleeding were analyzed retrospectively.Cervical cancer were documented by physical examination and tissue biopsy.Results There were obvious precipitating factors in most patients with severe vaginal hemorrhage.15 patients had vagina packed with gauze,3 had internal,2 had radiotherapy,and 3 had of the internal artery embolization.The last one had the best acquired effect.All theraies for treating shock,infection and hemostasis should be applied.Conclusion The precipitating factors of vaginal bleeding should be avoided.The traditional vaginal packing is still a reliable method to treat severe vaginal bleeding.Angiographic embolization is emerging as a successful procedure to control severe hemorrhage in patients with cervical cancer.