子宫动脉栓塞术治疗难治性产后出血疗效观察

目的探讨子宫动脉栓塞术治疗难治性产后出血的疗效。方法对48例因宫缩乏力、胎盘植入等原因发生难治性产后出血患者应用改良Seldinger技术行双侧子宫动脉造影并注入明胶海绵颗粒行栓塞术,其中胎盘植入患者栓塞前先行化疗药物MTX灌注。结果子宫动脉栓塞术后,患者阴道流血量明显减少,患者仅有轻微疼痛和不同程度的发热,无严重并发症,47例保留了生殖功能。结论子宫动脉灌注栓塞术具有止血迅速、创伤小、并发症及不良反应少等优点,是治疗难治性产后出血的有效方法。     

子宫动脉栓塞术治疗难治性产后出血36例临床分析

目的探讨子宫动脉栓塞术(uterine artery embolization,UAE)治疗难治性产后出血的疗效及意义。方法选取该院妇产科收治的难治性产后出血患者71例,根据治疗方式的不同分为观察组36例和对照组35例。观察组在常规治疗的基础上行双侧子宫动脉明胶海绵颗粒栓塞术;对照组应用常规的治疗方法,按摩子宫、缩宫药物注射、宫腔纱布填塞或者改良式B-Lynch缝合术等,上述方法无效时行子宫切除术。比较两组患者的止血效果、抢救输血量及术后并发症发生等情况。结果观察组UAE治疗后出血立即停止,有效率为100.00%,对照组中22例止血有效,有效率为62.86%,两组比较差异有统计学意义(χ2=16.368,P=0.000);两组抢救输血量分别为(1200±180)ml、(1597±182)ml,两组比较差异有统计学意义(t=9.241,P=0.000)。结论 UAE具有止血迅速、创伤小、并发症少等优点,是治疗难治性产后出血的有效方法,且节约了血源,保留了生殖功能,提高了产妇的生活质量。     

子宫动脉栓塞治疗剖宫产术后晚期产后出血22例临床分析

目的探讨子宫动脉栓塞术治疗剖宫产术后晚期产后大出血的疗效和并发症。方法 2010年1月至2013年6月,对22例剖宫产术后晚期产后大出血患者,采用seldinger技术行双侧子宫动脉插管和造影,明确出血部位及出血动脉分支,用明胶海绵颗粒栓塞双侧子宫动脉。结果 22例患者均30~70分钟内完成栓塞治疗,12例术后立即止血,10例出血明显减少,术后均生命体征平稳,经一周对症治疗后,出血均完全停止,复发1例经再次介入栓塞后治愈。栓塞后19例出现下腹部及会阴部疼痛;16例出现发热,经对症治疗后均得到有效缓解。结论使用子宫动脉栓塞介入治疗剖宫产术后晚期产后大出血,具有止血快、创伤小、可保留生育功能等优点,疗效好、不良反应少,有较高的临床应用价值。     

急诊子宫动脉栓塞治疗难治性产后出血10例分析

目的分析子宫动脉栓塞(uterine arterial embolization,UAE)治疗难治性产后出血(postpartum hemorrhage,PPH)的疗效与安全性。方法回顾性分析2014-01~2016-12在武汉儿童医院(武汉市妇幼保健院)住院分娩的难治性PPH介入治疗的10例患者的临床资料。所有患者经其他保守方法治疗无效后,采用UAE治疗。结果 10例患者均一次性栓塞成功,无远、近期并发症。结论难治性PPH用其他保守治疗无效的情况下,急诊UAE是一种迅速、有效、安全的止血方法。[关键词]难治性;产后出血;子宫动脉栓塞     

超选择动脉栓塞术治疗产后大出血40例体会

经导管动脉栓塞术（TAE）为产后大出血的治疗开辟了一条新途径。2005年7月～2006年10月,我科经导管髂内动脉栓塞（ILAE）及子宫动脉栓塞（UAE）治疗产后大出血40例。现报告如下。     

经导管动脉栓塞术治疗重度产后出血80例临床观察

目的探讨经导管动脉栓塞术（TAE）治疗重度产后出血的临床效果。方法对80例符合栓塞治疗指征的重度产后出血患者行TAE,观察手术时间、止血时间、出血量、子宫复旧情况、并发症。结果 80例均在30-60（45.2±5.1）m in完成TAE,其中43例术后3-15 m in阴道流血停止或明显减少,余37例术后第1-10天恶露显著减少、呈淡红色;出血量平均2 300 m l,子宫体按期复旧;均无严重并发症发生。结论 TAE治疗重度产后出血止血效果好、安全性高,但应准确掌握栓塞部位以减少并发症发生。     

经子宫动脉栓塞治疗子宫腺肌病57例疗效分析

近年来，子宫动脉栓塞术（UAE）治疗子宫肌瘤、产后出血等妇科疾病，取得满意疗效。1998年以来，我们采用UAE治疗子宫腺肌病，疗效良好。现报告如下。     

子宫动脉栓塞术治疗子宫肌瘤62例体会

2003年3月～2005年9月,我们应用子宫动脉栓塞（TUAE）治疗子宫肌瘤62例。现分析并报告如下。     

经导管子宫动脉栓塞术治疗子宫腺肌病临床观察

目的探讨经导管子宫动脉栓塞术（TUAE）治疗子宫腺肌病的疗效及安全性。方法对加例子宫腺肌病患者采用Seldlnger技术行经导管TUAE治疗。结果术后痛经完全缓解25例,明显缓鼹14例,6个月后复发1例。月经量减少至术前的55．2％±17．5％,月经周期无明显变化。栓塞后6个月,腺肌瘤体积与子宫体积平均缩小48．1％和39．6％,28例12个月平均缩小60．3％和44．8％。术后彩超检查显示子宫肌层及病灶内血流信号明显减少,后者减少更为明显。结论TUAE治疗子宫腺肌病疗效可靠,安全性高。     

子宫动脉栓塞术治疗子宫腺肌症110例疗效观察

目的 评价子宫动脉栓塞术（UAE）治疗子宫腺肌症的疗效.方法 采用UAE治疗子宫腺肌症患者110例.分别于术前、术后3个月、术后6个月行经阴道B超评估子宫大小,测量子宫动脉与卵巢动脉的最大血流速度、舒张期最低血流速度、子宫动脉阻力指数（RI）,计算子宫体积;采用ELISA法检测卵泡刺激素（FSH）、黄体生成激素（LH）、雌二醇（E2）水平;CLIA法检测CA125水平;随访患者月经周期的变化.术后3个月、6个月根据月经量和痛经情况进行评分评价症状改善情况.结果 本组110例均成功完成手术,未见明显卵巢功能紊乱、盆腔感染、闭经等严重并发症.UAE后子宫体积显著缩小,子宫动脉最大血流速度、CA125水平降低,子宫动脉RI升高（P均＜0.05）.卵巢血流指数、月经周期及激素水平治疗前后差异无统计学意义（P均＞0.05）.术后随访24～58个月,平均30.6个月.术后6个月复查,症状完全缓解58例,显著缓解45例,部分缓解5例,无变化2例,有效率98.2％.术后复发2例,并再次行UAE.结论 UAE治疗子宫腺肌症安全、有效,且可保留子宫及卵巢功能,适用于有生育需求的患者.     

子宫动脉灌注化疗及栓塞治疗剖宫产瘢痕妊娠疗效和失败因素分析

目的观察子宫动脉栓塞结合甲氨蝶呤(MTX)灌注治疗剖宫产瘢痕妊娠(CSP)疗效,并分析可能导致失败的三个因素。方法收集36例CSP患者并行双侧子宫动脉MTX灌注及栓塞治疗,其中6例重症阴道出血患者立即行介入手术治疗。通过血清β人绒毛膜促性腺激素(β-HCG)、超声、MR和临床症状评估临床效应。结果 34例患者成功实施介入治疗技术。6例大量阴道出血患者达到了立即止血目的。36例患者没有发生感染和子宫坏死,但有16例患者感到下腹疼痛。33例患者保存了子宫,3例行子宫切除术。结论经导管动脉灌注化疗栓塞术能有效治疗高风险CSP。合理的MTX用量、合适的栓塞材料和靶动脉完全栓塞是介入治疗成功的三个关键因素。     

Near-fatal uterine hemorrhage during induction chemotherapy for acute myeloid leukemia: a case report of bilateral uterine artery embolization

Severe transfusion-dependent uterine hemorrhage is a relatively uncommon complication of induction chemotherapy for acute myeloid leukemia (AML). Even less common is the failure of systemic conjugated estrogens in this setting. We report a case of life-threatening uterine hemorrhage in a 38-year-old woman in the setting of transfusion-refractory thrombocytopenia after completing induction chemotherapy for AML. She experienced dramatic breakthrough uterine hemorrhage despite multiple platelet transfusions, conjugated estrogens, recombinant factor VIIa, epsilon-aminocaproic acid, and intracavitary thrombin-soaked gauze tamponade. At the point of near-exsanguination in the setting of hypotension, hematocrit of 14%, and a platelet count of 3,000/microL, she underwent bilateral uterine artery embolization which proved immediately successful. We review the literature and indications for this procedure in the oncologic patient care setting.     

Peliosis hepatis during postpartum period: successful embolization of hepatic artery

Peliosis hepatis is a rare disorder characterized by the presence of blood-filled spaces in the liver, and it usually has a chronic presentation pattern. It has been reported mainly in adult patients in association with various pharmacological agents and infections. The present report concerns a postpartum patient in whom peliosis hepatis initially presented as active intraperitoneal hemorrhage from peliotic liver lesions, with no obvious etiology. We report here a 31-year-old woman who developed symptomatic peliosis hepatis and underwent superselective hepatic artery embolization, with control of the bleeding. We also present the sonographic, computed tomographic, and magnetic resonance images and laparoscopic findings. The patient recovered well and was discharged without any complaints. The pathogenesis in this patient remains unclear, but it is suggested that in her case estrogens and progesterone could not have been responsible for the development of peliosis hepatis.     

Transcatheter arterial embolization for hemorrhage caused by injury of the hepatic artery

BACKGROUND: The aims of the study were to compare (i) the effects of transcatheter arterial embolization on initial hemostasis and the control of rebleeding in the treatment of hemorrhage due to hepatic artery injury; and (ii) the outcomes of embolization by different locations. METHODS: Subjects were 32 patients with suspected hepatic artery injury who were transferred to Chi-Mei Foundation Medical Center for hepatic angiography and embolization. The causes of arterial injury included liver trauma (n = 15) and iatrogenic injury (n = 17). The sites of embolization were classified into four groups: group 1 (n = 8) was classified as 'combined outlet, target and inlet control' with embolization of the vascular lesion (target) and hepatic artery distal (outlet) and proximal (inlet) to the vascular lesion simultaneously; group 2 (n = 11) as 'combined target and inlet control'; group 3 (n = 8) as 'combined outlet and inlet control'; group 4 (n = 5) as 'inlet control' only. RESULTS: Successful initial hemostasis was achieved in 30 of the 32 patients (93.8%), with two failures, both of which were caused by liver injury and occurred in subjects in group 4. Rebleeding was seen in three patients who had successful initial hemostasis: two of them in group 4 (66.7%) and one in group 1 (12.5%). All rebleedings were successfully managed by repeat embolization. Abscess formation was found in two group 1 patients, and both were successfully managed by percutaneous drainage. CONCLUSIONS: Transcatheter arterial embolization is an effective method for hemostasis in hepatic artery hemorrhage for both patients with liver trauma and patients with iatrogenic injuries to the hepatic artery. Based on this experience, embolization of the vascular lesion and/or the arterial lumen distal to the vascular lesion combined with inlet control is recommended for preventing recurrent hemorrhage, but studies with larger sample sizes will be required to validate this conclusion.     

支气管动脉栓塞治大咯血38例临床研究

目的观察支气管动脉栓塞术对大咯血患者的临床疗效。方法 2000年至2008年因大咯血住院患者,经胸部影像学检查或纤维支气管镜、支气管动脉造影明确诊断的患者行支气管动脉栓塞术。结果共38例患者,男26,女12例,年龄56±9岁,反复咯血31例,支气管扩张27例,支气管肺囊肿4例,不明原因4例,肺结核3例。支气管动脉造影均表现为血管畸形,给予支气管动脉栓塞治疗35例出血立即减少,1周内完全消失。随访1年,复发大咯血2例。治疗后3例短时间内轻微胸痛,2例肩痛,3例伴胸闷,3例腹股沟皮下淤血,对症处理后短期内好转。结论支气管动脉栓塞术对治疗急性或反复发生的大咯血非常有效,可以使患者避免外科手术的风险,对复发患者再次治疗也安全有效。     

58例产后出血的观察与处理

目的 分析产后出血的相关因素及防治措施.方法 回顾性分析58例产后大出血病例的临床资料.结果 同期产后出血发生率3.18%,56例经保守治疗获痊愈,2例行子宫切除术,无一例死亡.结论 准确判断出血原因,争取及时正确有效的防治措施是处理产后出血的关键.     

Total splenic artery embolization for splenic artery aneurysms in patients with normal spleen

AIM:To evaluate total embolization of the main splenic artery in patients with splenic artery aneurysms(SAAs)and normal spleen.METHODS:Thirty-five consecutive patients with SAAs were referred for treatment with coil embolization.Patients were classified into two groups:coil embolization of the main splenic artery with complete occlusion of the artery and aneurysms(group A,n=16),and coil embolization of the aneurysmal sac with patency of the splenic artery(group B,n=19).Data on white blood cell(WBC)and platelet counts,liver function,and complications were collected on days 7 and 30,and subsequently at a 6-mo interval postoperatively.Abdominal computed tomography was routinely performed to calculate the splenic volume before and 1 mo after the procedure,and subsequently every 6 mo during follow-up.RESULTS:Coil embolization of the SAAs was technically successful in all 35 patients,with no procedurerelated complications.The post-embolization syndrome,including abdominal pain,fever and vomiting,occurred in six patients(37.5%)in group A and three patients in group B(15.8%).There were no significant differences in WBC and platelet counts between preoperatively and at each follow-up point after the procedures.There were also no significant differences in average WBC and platelet counts between the two groups at each follow-up point.There were significant differences in splenic volume in group A between preoperatively and at each follow-up point,and there were also significant differences in splenic volume between the two groups at each follow-up point.CONCLUSION:Total embolization of the main splenic artery was a safe and feasible procedure for patients with SAAs and normal spleen.     

益母草注射液联合缩宫素预防剖宫产产后出血及促进子宫复旧的临床研究

目的：探讨益母草注射液联合缩宫素预防剖宫产产后出血及促进术后子宫复旧效果。方法选择孕龄＞28周行剖宫产患者360例,分为治疗组180例,用益母草注射液联合缩宫素治疗;对照组180例,单纯用缩宫素治疗。观察两组产妇术中及术后不同时段出血量、产后出血例数、不同时段子宫收缩情况、子宫复旧情况,较术前血红蛋白下降程度等。结果治疗组各个时段出血量少于对照组,差异有统计学意义（P＜0．05）。治疗组各个时段子宫收缩情况均好于对照组,其中术中、术后2 h、6 h差异有统计学意义（ P＜0．05）。两组术后3 d、5 d子宫底下降幅度比较差异有统计学意义（ P＜0．05）。两组术后48 h与产前血红蛋白下降程度＜1 g／L、1-2 g／L、＞2 g／L比较差异有统计学意义（ P＜0．05）。结论益母草注射液联合缩宫素预防剖宫产产后出血及促进子宫复旧疗效确切,可作为防治产后出血和子宫复旧的优选治疗方案。