髂内动脉栓塞治疗难治性产后出血——附5例报告

目的　探讨髂内动脉栓塞治疗难治性产后出血的临床价值。　方法　用介入放射技术对 5例产后出血患者行骼内动脉数字减影血管造影 (DSA) ,明确盆腔血管走向及造影剂由血管外溢情况 ,以明胶海绵碎粒与稀释之造影剂混合栓塞双侧髂内动脉。　结果　 5例经髂内动脉造影均显示了不同临床原因引起的出血图象 ,经栓塞后出血随之停止 ,但 1例腹腔再度出血 ,剖腹探查发现为右侧卵巢血管及圆韧带残端出血。　结论　髂内动脉栓塞技术应用于难治性产后出血能迅速止血 ,保留子宫 ,抢救病人生命     

选择性子宫动脉栓塞治疗产后出血

目的观察选择性子宫动脉栓塞治疗产后出血的疗效。方法回顾性分析21例接受选择性子宫动脉栓塞的产后出血患者,均伴有失血性休克,应用明胶海绵碎屑进行栓塞。结果栓塞术后,所有患者出血停止,血压上升,心率减慢,血红蛋白上升,与术前比较差异有统计学意义（P〈0.05）。术后随访1年,无复发出血及严重并发症发生。结论选择性子宫动脉栓塞是治疗产后出血微创、有效的方法。     

子宫动脉栓塞术治疗难治性产后出血效果观察

目的探讨子宫动脉栓塞术治疗难治性产后出血的临床效果。方法对2013-10—2014-10间收治的36例难治性产后出血患者,在给予常规保守治疗无效后行子宫动脉栓塞术,观察治疗效果。结果本组36例患者均一次栓塞介入治疗成功止血,手术时间(35.1±48.9)min;止血时间(6.2±1.5)min。结论子宫动脉栓塞术治疗难治性产后出血,效果好、创伤小、术后并发症发生少。     

子宫动脉栓塞介入治疗产后出血56例临床分析

目的探讨子宫动脉栓塞介入治疗产后出血的临床疗效。方法将56例产后出血患者随机分为2组各28例。对照组采用传统手术方法治疗;观察组采用子宫动脉栓塞介入治疗。比较2组疗效。结果观察组有效止血率为100%,显著高于对照89.3%(P<0.05);手术时间及术后并发症发生率,观察组明显低于对照组,P<0.05。结论子宫动脉栓塞介入治疗产后出血具有手术时间短、止血迅速、创伤小、可保留子宫且并发症少等特点,效果肯定     

髂内动脉栓塞治疗难治性产后出血一附5例报告

目的：探讨髂内动脉栓塞治疗难治性产后出血的临床价值。方法：用介入放射技术对5例产后出血患行骼内动脉数字减影血管造影（DSA），明确盆腔血管走和骸造影剂由血管外溢情况，以明胶海绵碎粒与稀释之造影剂混合栓塞双侧髂内动脉。结果：5你经髂内动脉造影均显示了不同临床原因引起的出血图象，经栓塞后血随之停止，但1例腹腔再度出血，剖腹探 现为右侧卵巢血管及圆韧带残端出血。结论：髂内动脉栓塞技术应用于难治性产后出血迅速止血，保留子宫，抢救病人生命。     

经导管子宫动脉栓塞术治疗剖宫产后难治性晚期出血

目的探讨经导管子宫动脉栓塞术（TUAE）治疗剖宫产后难治性晚期出血的价值。方法对23例剖宫产后难治性晚期出血患者,以明胶海绵颗粒进行TUAE,观察治疗效果,并对数字减影血管造影（DSA）表现进行分析。结果 22例患者经导管TUAE术后均止血成功,1例术后仍有阴道流血,行全宫切除术,发现为剖宫产术中将大网膜与子宫缝合在一起所致;DSA示动脉早期见对比剂外溢（20例）,血管畸形（3例）。本组病例未发生严重并发症。结论 TUAE治疗剖宫产后难治性晚期出血快速、准确、创伤小,值得推广。     

整体护理在产后大出血子宫动脉栓塞术患者中的临床应用效果

目的探讨整体护理(OC)对子宫动脉栓塞术(UAE)治疗产后大出血(PPMH)患者的应用价值。方法将100例PPMH伴失血性休克患者随机分为OC组和传统护理(TN)组各50例。两组均经保守治疗无效后接受UAE治疗。对OC组实施OC干预,而对TN组实施TN干预。比较两组患者状态焦虑量表(SAI)评分、一次性栓塞成功率、阴道出血量、并发症发生率、患者及其家属满意度、健康教育率、住院天数及术后月经状况。结果入院第1天,两组SAI评分均较高,二者间差异无统计学意义(P0.05);UAE治疗前1天及出院当天两组SAI评分差异均有统计学意义(P均0.05)。OC组一次性栓塞成功率高于TN组,阴道出血量及并发症发生率低于TN组(P均0.05);且OC组患者满意度、健康教育率均高于TN组,住院时间短于TN组(P均0.05)。两组患者术后月经情况均逐渐恢复正常。结论对接受UAE治疗的PPMH患者采用OC护理方案有利于提高治疗效果。     

子宫动脉栓塞术治疗产后大出血效果观察

目的分析子宫动脉栓塞术治疗产后大出血的效果。方法对42例产后大出血患者应用子宫动脉栓塞术治疗。观察手术时间,止血时间、一次性止血成功率,月经周期恢复正常时间等指标。结果本组40例(95.2%)一次性止血成功,2例因止血不完全而行子宫次全切除术。5例(11.9%)患者术后出现低热(37.6℃~38.5℃)、恶心、呕吐等症状,经对症处理后消失。未发生宫腔粘连等其他并发症。手术时间(53.4±34.8)min,术后阴道流血完全停止时间(6.3±1.9)d。术后随访12个月,均未发生产后晚期出血,除2例行子宫次全切除术产妇外,余40例均恢复正常月经周期。结论子宫动脉栓塞术治疗产后大出血,止血迅速,并发症少,患者恢复快。     

超选择性髂内动脉分支栓塞治疗前列腺癌术后出血3例

目的 评价超选择性髂内动脉分支栓塞治疗前列腺癌术后出血的疗效.方法 应用大小不等的弹簧钢圈或PVA颗粒,对3例前列腺癌根治术后盆腔出血患者进行超选择性髂内动脉分支栓塞术.结果 栓塞后出血均停止,血红蛋白水平保持平稳,持续随访无再发出血.结论 超选择性髂内动脉分支栓塞术是一种有效治疗前列腺癌根治术后盆腔出血的方法.     

产后出血性休克患者行急诊动脉栓塞治疗的护理

对7例产后出血性休克患者行急诊子宫动脉栓塞治疗。结果7例患者均迅速止血，痊愈出院。提出除积极参与产后出血性休克的抢救外，术前予以心理沟通，术中熟练的手术配合及术后精心的护理是确保手术成功和促进患者康复的重要保障。     

3D-DSA在盆壁肿瘤术前介入栓塞中的价值

目的评价骨盆肿瘤术前单纯栓塞疗效和旋转DSA及三维重建对指导介入手术的价值。方法22例盆壁病变术前行单纯介入栓塞治疗,外科手术时机为介入手术后24小时内,栓塞材料为明胶海绵,计算术中估计失血量;其中11例进行旋转DSA及三维重建,与传统正位DSA指导下比较手术时间、透视时间及造影剂用量的差异。结果22例患者术中估计失血量为(1188.5±684.4)ml;旋转DSA及三维重建组病例与传统正位DSA组比较,手术时间和造影剂用量无差异(P>0.05),透视时间明显减少(P<0.05)。结论术前24小时内行明胶海绵颗粒单纯栓塞可明显减少盆壁病变术中出血,旋转DSA及三维重建技术对介入手术操作具有重要指导意义。     

Pelvic arterial embolization in the setting of acute hemorrhage as a result of the anterior Prolift® procedure

Acute hemorrhage following pelvic reconstructive surgery is a complication requiring immediate evaluation and treatment. Therapeutic options include fluid resuscitation, tamponade techniques, exploratory surgical intervention, and, more recently, pelvic vessel embolization. New approaches to pelvic organ prolapse have been evolving rapidly with little reported on safety and efficacy. We present a 77-year-old female who had a life-threatening acute pelvic hemorrhage from an anterior Prolift^® procedure successfully treated with pelvic artery embolization.     

Control of severe hemorrhage using C-clamp and arterial embolization in hemodynamically unstable patients with pelvic ring disruption

Introduction

Hemorrhage is the leading cause of death in patients with a pelvic fracture. The majority of blood loss derives from injured retroperitoneal veins and broad cancellous bone surfaces. The emergency management of multiply injured patients with pelvic ring disruption and severe hemorrhage remains controversial. Although it is well accepted that the displaced pelvic ring injury must be rapidly reduced and stabilized, the methods by which control of hemorrhagic shock is achieved remain under discussion. It has been proposed to exclusively use external pelvic ring stabilization for control of hemorrhage by producing a ‘tamponade effect’ of the pelvis. However, the frequency of clinically important arterial bleeding after external fixation of the pelvic ring remains unclear. We therefore undertook this retrospective review to attempt to answer this one important question: How frequently is arterial embolization necessary to control hemorrhage and restore hemodynamic stability after external pelvic ring fixation?

Materials and methods

We performed a retrospective review of 55 consecutive patients who presented with unstable types B and C pelvic ring fractures. Those patients designated as being in hemorrhagic shock (defined as a systolic blood pressure less than 90 mmHg after receiving 2 L of intravenous crystalloid) were treated by application of the pelvic C-clamp. Patients who remained in hemorrhagic shock, or were determined to be in severe shock (defined as mandatory catecholamines or more than 12 blood transfusions over 2 h), underwent therapeutic angiography within 24 h in order to control bleeding.

Results

Fourteen patients were identified as being hemodynamically unstable (ISS 30.1±11.3 points) and were treated with a C-clamp. In those patients with persistent hemodynamic instability, arterial embolization was performed. After C-clamp application, 5 of 14 patients required therapeutic angiography to control bleeding. Two patients died, one from multiple sources of bleeding and the other from an open pelvic fracture (total mortality 2/14, 14%).

Conclusions

Although the C-clamp is effective in controlling hemorrhage, one must be aware of the need for arterial embolization to restore hemodynamic stability in a select subgroup of patients.

     

Glubran-2胶用于子宫动脉栓塞治疗产后出血伴凝血功能障碍患者子宫动脉假性动脉瘤

目的 观察以Glubran-2胶行子宫动脉栓塞(UAE)治疗产后出血伴凝血功能障碍患者子宫动脉假性动脉瘤(UAP)的价值。方法 回顾性纳入13例接受Glubran-2胶UAE治疗的产后出血伴凝血功能障碍UAP患者,包括产后即刻出血8例、迟发性产后出血5例;共17个UAP,其中10例1个、2例2个、1例3个UAP;观察UAE技术成功率、临床治疗成功率、复发率、并发症率、产后恢复月经来潮时间及UAE后生育情况。结果 13例UAE中,11例采用Glubran-2胶联合明胶海绵颗粒进行栓塞、2例单独以Glubran-2胶进行栓塞,Glubran-2胶用量为0.3~2.2 ml/例;UAE技术成功率和临床治疗成功率均为100%。UAE后随访3~75个月,未见严重并发症及复发出血;2例于UAE后2日发热,经抗感染治疗后好转。13例均于产后2~6个月、中位时间4个月恢复月经来潮,且均无再生育意愿。结论 以Glubran-2胶行UAE治疗产后出血伴凝血功能障碍患者UAP安全、有效。     

胃肠道动脉性大出血的急诊介入治疗

目的探讨急性胃肠道动脉性大出血的急诊血管造影检查及栓塞治疗的临床价值。方法对25例急性胃肠道动脉性大出血患者行急诊腹腔动脉、肠系膜上动脉、肠系膜下动脉造影,并对可疑部位行超选择性血管造影,明确出血部位后,用明胶海绵条或颗粒、弹簧圈及聚乙烯醇（PVA）颗粒对出血动脉行栓塞治疗。术后密切观察患者生命体征变化,并定期追踪随访。结果25例患者中,22例出血部位明确并栓塞止血成功,3例未找到出血动脉,技术成功率达88．oo％（22／25）。术后随访3～20个月,中位时间6．5个月,未见严重并发症发生及再次出血。结论急诊介入治疗是急性胃肠道动脉性大出血安全、有效的治疗手段。     

Current role of transcatheter arterial embolization for bladder and prostate hemorrhage

Intractable hematuria from the bladder or the prostate can be life-threatening and its management remains a difficult clinical problem. Severe bleeding can arise as a result of radiation cystitis, bladder carcinoma, cyclophosphamide-induced cystitis, severe infection, transurethral resection of the prostate and prostate cancer. When irrigation of the bladder through a three-way catheter and fulguration of the bleeding lesions fail to stop the hematuria, a life-threatening situation can develop, when blood transfusion fails to keep pace with the rate of blood loss. Patients with massive uncontrollable hematuria are often elderly and unfit for cystectomy as a treatment. Many urologists have had to manage this difficult problem, and several different treatments have been attempted and described, with varying degrees of success. Transcatheter arterial embolization of the vesical or prostatic arteries is occasionally indicated in these patients when all other measures have failed. There is limited published experience with this procedure, but success in 90% of patients is reported when the vesical or prostatic arteries can be identified. The aim of this review is to describe the current place of transcatheter arterial embolization in the management of severe bladder or prostate bleeding after failed conservative therapy, and to review its efficacy and morbidity.