难治性产后出血干预性治疗方法的对比研究

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．

A comparative study of surgical interventions used for the treatment of intractable postpartum hemorrhage

Objective To assess the application of various surgical interventions used for the treatment of intractable postpartum hemorrhage.Methods From January 1998 to August 2003,88 patients with intractable postpartum hemorrhage were performed various interventions including uterine packing,bilateral hypogastric artery ligation (BHAL),transcatheter arterial embolization (TAE) and others.Results All patients were rescued successfully;12 out of 18(66 7%) undergoing uterine packing achieved success;BHAL was performed successfully in 4 out of 12(33\^3%),all of 30(100%) cases with TAE stopped bleeding,36 of 42(85 7%) cases receiving hysterectomy,or combining with pelvic packing,were treated successfully.Conclusion Uterine packing can arrest bleeding.TAE may be an effective alternative to hysterectomy.When uterine factors become the causes of disseminated intravascular coagulation (DIC),hysterectomy is necessary.