子宫动脉栓塞术治疗剖宫产术后子宫瘢痕妊娠的结局分析

目的 研究子宫动脉栓塞术治疗剖宫产术后子宫瘢痕妊娠的结局.方法 分析2014年5月-2016年5月诊治的74例剖宫产术后子宫瘢痕妊娠患者临床资料,患者均经阴道超声确诊,采用子宫动脉栓塞术治疗,观察临床治疗效果.结果 74例患者均保留子宫,患者均在子宫动脉栓塞术后2-5天内行清宫术,行清宫术的患者中4例术中出血大于500 mL,中转开腹行子宫疤痕切除、子宫修补术,术后住院时间8-21天,平均住院时间(13.76±1.08)天;随访3个月,74例患者月经均恢复.结论 子宫动脉栓塞术治疗剖宫产术后子宫瘢痕妊娠可有效降低大出血的风险,最大化保留生育功能,且无严重并发症,值得临床推广和应用.     

子宫动脉化疗输注加栓塞术治疗剖宫产后子宫切口妊娠

目的:探讨子宫动脉化疗输注加栓塞术对剖宫产后子宫切口妊娠的应用价值。方法:对9例剖宫产后子宫切口妊娠患者急诊行双侧子宫动脉超选择性插管,输注氨甲喋呤(MTX)后,再用明胶海绵颗粒栓塞双侧子宫动脉,1周内再在B超引导下行刮宫术或吸宫术。结果:9例患者均成功施行了子宫动脉化疗输注加栓塞术,1周内顺利行刮宫术或吸宫术,术中出血量少。结论:子宫动脉化疗输注加栓塞术为剖宫产后子宫切口妊娠患者的保守治疗提供了安全保障,使患者避免子宫被切除,是一种安全、有效的治疗方法。     

急诊子宫动脉栓塞治疗产后胎盘植入大出血

目的 探讨急诊子宫动脉栓塞(UAE)治疗产后胎盘植入大出血的方法和疗效.资料与方法 在数字减影机下采用改良式Seldinger技术对7例胎盘植入患者穿刺插管行盆腔动脉造影,明确出血血管后将5 F Cobra导管超选择插入出血侧子宫动脉,立即用明胶海绵颗粒和明胶海绵条栓塞.术后肌注甲氨喋呤并口服米非司酮各一个疗程.结果 7例胎盘植入患者均找到出血位置并一次性栓塞成功,成功率100%.手术时间25～50 min,平均(35.2±5.3)min,术后3～12 min阴道流血停止,平均(5.2±2.4)min,术后患者血压迅速回升至正常,生命体征稳定.术后1天～4周6例排出胎盘组织,平均排出时间15.4天,子宫如期复旧,血绒毛膜促性腺激素(β-HCG)恢复正常,跟踪随访月经正常,自测排卵正常.结论 急诊UAE治疗胎盘植入大出血具有手术时间短、创伤小、疗效肯定和可保留子宫等优点,有较好的临床应用价值.     

Usefulness of Pelvic Artery Embolization in Cesarean Section Compared with Vaginal Delivery in 176 Patients

PurposeTo evaluate the efficacy and safety of transcatheter arterial embolization of the pelvic arteries for the treatment of postpartum hemorrhage (PPH) associated with cesarean section compared with vaginal delivery.Materials and MethodsA retrospective analysis of 176 patients undergoing transcatheter arterial embolization of the pelvic arteries for PPH from January 2006 through August 2011 was conducted at two institutions. The mean patient age was 33.9 years (range, 24–46 years). Data including delivery details, hematology and coagulation results, embolization details, and clinical outcomes were collected. Technical success was defined as cessation of bleeding on angiography or angiographically successful embolization of the bleeding artery. Clinical success was defined as the obviation of repeated embolization or surgical intervention.ResultsThe technical success rate was 98.8% (n = 174), and the clinical success rate was 89.7% (n = 158). Among 176 patients, 71 had cesarean sections, and 105 underwent normal vaginal deliveries. Of the 105 patients who underwent normal vaginal deliveries, 11 (10.5%) required repeat embolization or surgical intervention. Of the 71 patients who had cesarean sections, 7 (9.8%) required repeat embolization or surgical intervention. The clinical success rate and complication rate were not related to the mode of delivery. All women resumed menses after transcatheter arterial embolization, and most (n = 125) described their menses as unchanged. Subsequent spontaneous pregnancies occurred in 13 women.ConclusionsThe cesarean mode of delivery is not a predictor of poorer outcomes of transcatheter arterial embolization; however, further study is needed to clarify this relationship.     

双侧子宫动脉栓塞术对预防和治疗产后出血的临床应用价值

目的：探究双侧子宫动脉栓塞术对预防和治疗产后出血的临床应用价值。方法54例出现难治性产后出血患者（治疗组）及40例具有产后出血高危因素的患者（预防组）均进行双侧子宫动脉栓塞术,观察疗效及出现的不良反应等。结果治疗组产妇治疗前已出现产后出血,出血量1100～4300 mL,平均2100 mL,辅助性背带缝合3例,宫腔填纱13例;预防组产妇出血量为210～490 mL,平均370 mL,所有患者均未发生产后出血;栓塞术后52例患者均有效,有效率96.3％,患者术后均未出现不良反应。结论双侧子宫动脉栓塞术是一种安全有效且不良反应小的治疗手段,对产后大出血高危因素患者有预防作用,是治疗难治性产后出血的有效方法。     

子宫动脉栓塞术预防和治疗子宫大出血的临床效果

目的探讨子宫动脉栓塞术预防和治疗子宫大出血的临床效果。资料与方法对12例人工流产大出血、胎盘植入性大出血和宫颈妊娠为主要表现的患者用明胶海绵颗粒进行双侧子宫动脉栓塞术,观察治疗效果。结果 12例患者全部栓塞成功,随访2～5个月无再次大出血,无严重并发症。结论子宫动脉栓塞术预防和治疗子宫大出血是一种安全、微创和有效的治疗方法,而且可以保留患者的子宫和生育功能,值得临床推广应用。     

剖宫产疤痕妊娠的子宫动脉栓塞并清宫治疗

目的 探讨子宫动脉栓塞后清官对剖宫产疤痕妊娠(cesarean scar pregnancies,CSP)的治疗价值.资料与方法 对14例CSP患者行子宫动脉栓塞后在超声引导下清宫,记录手术时和术后阴道出血量、有无术后残留及再发出血,并随访月经及再次妊娠情况.结果 14例术中出血5～20 ml,平均11.5 ml,术后均无宫内残留,无再发出血.有2例再次怀孕,1例孕11周行人流,1例孕33+2周产下一健康男婴.结论 子宫动脉栓塞后清宫既能控制出血量,又保留了女性生育机能,是治疗CSP的一种安全、有效的方法,但对其他类型CSP的治疗价值有待探讨.     

MR Reproducibility in the Assessment of Uterine Fibroids for Patients Scheduled for Uterine Artery Embolization

Magnetic resonance imaging (MRI) is increasingly applied in the evaluation of uterine fibroids. However, little is known about the reproducibility of MRI in the assessment of uterine fibroids. This study evaluates the inter- and intraobserver variation in the assessment of the uterine fibroids and concomitant adenomyosis in women scheduled for uterine artery embolization (UAE). Forty patients (mean age: 44.5 years) with symptomatic uterine fibroids who were scheduled for UAE underwent T₁- and T₂-weighted MRI. To study inter- and intraobserver agreement 40 MR images were evaluated independently by two observers and reevaluated by both observers 4 months later. Inter- and intraobserver agreement was calculated using Cohen’s κ statistic and intraclass correlation coefficient for categorical and continuous variables, respectively. Inter-observer agreement for uterine volumes (κ = 0.99, p < 0.0001), dominant fibroid volumes (κ = 0.98, p ≤ 0.0001), and number of fibroids (κ = 0.88; CI, 0.77–0.93; p < 0.0001) was excellent. For the T₁- and T₂-weighted signal intensity of the dominant fibroid there was good agreement between the observers (87%; 95% CI, 71.9%–95.6%) and the intraobserver agreement was good for observer A (95%; 95% CI, 83.1%–99.4%) and moderate for observer B (κ = 0.47). The interobserver agreement with respect to the presence of adenomyosis was good (κ = 0.73, p < 0.0001), while both intraobserver agreements were fair to moderate (observer A, κ = 0.55, p = 0.0003; and observer B, κ = 0.66, p < 0.0001). In conclusion, MRI criteria used for the selection of suitable UAE patients show good inter- and intraobserver reproducibility.     

Uterine Artery Embolization following Cesarean Delivery but prior to Hysterectomy in the Management of Patients with Invasive Placenta

PurposeTo evaluate outcomes of patients with placenta accreta spectrum (PAS) disorders who underwent uterine artery embolization (UAE) following cesarean delivery but before hysterectomy.Materials and MethodsA retrospective review of patients with PAS treated with cesarean-hysterectomy (C-hyst) was performed. Patients in the UAE group underwent UAE after cesarean delivery but before hysterectomy; patients in the control group underwent C-hyst alone. Estimated blood loss (EBL), transfusion requirements, length of intensive care unit (ICU) stay, and adverse events were evaluated.ResultsThe study included 31 patients, 7 in the UAE group and 24 in the control group. Median EBL, transfusion requirements, and length of ICU stay in the UAE group compared with control group were 1,500 mL (range, 500–2,000 mL) vs 2,000 mL (range, 1,000–4,500 mL) (P = .04), 150 mL (range, 0–650 mL) vs 550 mL (range, 0–3,125 mL) (P = .10), and 0 d (range, 0–1 d) vs 0.5 d (range, 0–2 d) (P = .07). All patients in the UAE group had placenta increta; patients in the control group had placenta accreta (29%), increta (54%), and percreta (17%) (P = .10). Subgroup analysis of patients with placenta increta demonstrated that the UAE group had a significant decrease in median EBL (P = .004), transfusion requirements (P = .009), and length of ICU stay (P = .04). No adverse events following UAE were noted.ConclusionsUAE following cesarean delivery but before hysterectomy in patients with placenta increta appears to be safe and effective in decreasing EBL, transfusion requirements, and length of ICU stay compared with C-hyst alone.     

Risk Factors Associated with Clinical Failure of Uterine Artery Embolization for Postpartum Hemorrhage

PurposeTo identify risk factors for clinical failure of uterine artery embolization (UAE) for postpartum hemorrhage (PPH), with particular attention to the uterine artery diameter.Materials and MethodsThis retrospective study included 47 patients who underwent UAE for PPH between January 1, 2010, and January 31, 2021. Technical success was defined as the completion of embolization of the arteries thought to be the cause of the bleeding. Clinical success was defined as no recurrent bleeding or need for additional therapeutic interventions. Univariate and multivariate analyses were performed to examine the risk factors associated with clinical failure of UAE.ResultsOf the 47 patients, 6 had recurrent bleeding. Of the 6 patients, 4 underwent hysterectomy, and 2 underwent repeat embolization. The clinical success rate was 87.2% (41/47), with no major adverse events such as uterine infarction or death. In univariate analysis, there were slight differences in multiparity (P = .115) and placental abruption (P = .128) and a significant difference in the findings of a narrow uterine artery on digital subtraction angiography (DSA) (P = .005). In multivariate analysis, only a narrow uterine artery on DSA was a significant factor (odds ratio, 18.5; 95% confidence interval, 2.5–134.8; P = .004).ConclusionsA narrow uterine artery on DSA was a risk factor for clinically unsuccessful UAE for PPH. It may be prudent to conclude the procedure only after it is ensured that vasospasm has been relieved.     

Efficacy and Safety of Prophylactic Uterine Artery Embolization in Pregnancy Termination with Placenta Previa

CardioVascular and Interventional Radiology - To appraise the efficacy and safety of prophylactic uterine artery embolization in pregnancy termination with placenta previa. A cohort of 54...     

子宫动脉栓塞治疗子宫肌瘤的研究现状

子宫肌瘤是女性生殖系统中最常见的良性肿瘤[1～ 4 ] 。年龄5 0岁左右未闭经的妇女中发病率高达 40 %以上[1 ,2 ,5] 。它是子宫非急性异常出血最常见的原因[1～ 8] 。随着肌瘤体积增大 ,引起下腹部疼痛、腰骶部不适、腹胀、尿频、肾盂积水、性交疼痛、不孕等[1～ 9] 。长期、大量出血引起缺铁性贫血[2 ,4 ,6 ,8] 。传统治疗方法 [手术、冷冻、激光及内分泌 (激素 )等 ]由于存在着各自的缺陷不足 ,临床应用受到限制[2 ,6～ 8] 。子宫动脉栓塞 (ＵＡＥ)治疗子宫肌瘤最初由Ｒａｖｉｎａ等[4 ,1 0 ] 于1995年报道 ,此后 ,该技术得到了广泛开展[2…