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

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。

Clinical analysis of selective uterine artery embolization for 13cases of intractable postpartum hemorrhage

Objective To study the opportunity , curative effect and complications of selective uterine artery embolization (SUAE) on intractable postpartum hemorrhage.Methods Uterine artery embolization was performed in 13patients of intractable postpartum hemorrhage by digital subtraction angiography (DSA) technology.Results The average blood loss was 1 200ml (1 200±1 215) ml during partum and 2 555ml (2 555±995) ml postpartum.A lot of hemostasis methods had been performed before SUAE including uterine massage , injection of carboprost and uterine artery ligation but all failed.Blood loss was significant reduced in 12 patients after SUAE.One patient still had severe hemorrhage and underwent hysterectomy.There was different degree of coagulation disorder in these 13 patients , SUAE was performed while coagulopathy was addressing.No severe complications occurred and the most common symptom was after SUAE fever.Conclusion Blood coagulation disorder is not contraindication for SUAE.SUAE is an effective method for postpartum hemorrhage with less complications.