导管动脉栓塞术在难治性产后出血中的应用

目的　探讨经导管动脉栓塞术（TAE）在难治性产后出血中的应用价值。方法　以Seldinger技术对14例难治性产后出血患者，行经皮双髂内动脉前干或子宫动脉超选择插管术，应用数字减影血管造影（DSA）技术明确出血部位后灌注抗生素(头孢噻甲羧肟)，并以明胶海绵颗粒栓塞。结果　（1）14例经保守治疗无效的难治性产后出血患者，经TAE治疗后一次性止血成功，止血时间3～10min，平均时间(6.1±3.6)min，手术时间30～50min，平均（41.8±6.4）min；（2）应用DSA发现，出血均来源于单侧或双侧子宫动脉，表现为宫腔内弥漫性、局灶性出血或单侧子宫动脉分支出血；（3）随访2～60个月，14例患者均恢复规律月经，无严重并发症发生。结论　应用TAE治疗难治性产后出血有较好的临床效果，具有止血快、并发症少的特点。

Transcatheter arterial embolization in intractable postpartum hemorrhage

OBJECTIVE: To asses the value of transcatheter arterial embolization treatment in intractable postpartum hemorrhage. METHODS: Fourteen patients of postpartum hemorrhage failed to the drugs treatment were performed transcatheter arterial embolization (TAE). Superselective catheterization to the bilateral uterial arteries or anterior branches of internal iliac arteries was carried out after intubation to single-side femoral artery by Seldinger's technique. When the catheter tip was proved in right place by digital substraction angiography (DSA) techniques, antibiotic solution was poured into arteries and then the arterial embolization with gelfoam particles was followed. RESULTS: All the patients were performed TAE successfully. The duration of TAE was 30-50 minutes mean (41.8 +/- 6.4) minutes]. Bleeding was found in DSA mostly as diffuse intrauterine flow outward sign from one side or both side of uterial artery branches. After one time of TAE, the vaginal bleeding of all patients was stopped in 3-10 minutes mean (6.1 +/- 3.6) minutes]. The follow-up showed that all patients had normal menstrual periods in 2-60 months and no serious complications were found. CONCLUSION: With the characteristic of fast homeostasis and less complications, TAE was proved to be an effective method for intractable postpartum hemorrhage.