盆腔动脉栓塞术治疗难治性产后大出血的临床分析

目的讨论盆腔动脉栓塞术（PAE）治疗难治性产后大出血（PPH）的安全性和可行性，并评估影响其临床成功率的因素。 方法回顾性分析需要做PAE手术的25例难治性PPH患者，分娩方式、出血的病因、详细的生化资料和治疗措施及临床结果都被记录下来，对影响临床结果的各种可能因素进行了单变量及多变量分析。 结果临床成功率为92.00%（23/25），其余2例需要再次栓塞。产后出血控制成功率为96.00%（24/25），其余1例于二次PAE术后死于低血容量休克。长期随访的23例患者术后均恢复了月经，其中4再次成功受孕。统计分析显示PPH后PAE术临床成功率与患者的分娩方式、并发弥散性血管内凝血(DIC)、大量输血（超过10个单位的压积红细胞）有关。 结论PAE治疗PPH的最终临床成功率达96.00%，是安全有效的，对于合并DIC或需要大量输血的患者术后应密切观察。

Clinical analysis of pelvic arterial embolization for treatment of primary postpartum hemorrhage

ObjectiveTo evaluate the safety and efficacy of pelvic arterial embolization (PAE) for treatment of primary postpartum hemorrhage (PPH), and to determine the factors associated with clinical outcomes. MethodsA total of 25 patients who underwent PAE for primary PPH were retrospectively analyzed. Mode of delivery, causes of primary PPH, detailed laboratory and treatment records, and clinical outcomes were recorded. Univariate and multivariate analyses were performed to determine the factors related to clinical outcomes. ResultsClinical success was achieved in 23 patients (23/25, 92.00%), the other 2 patients underwent repeat PAE. Overall bleeding control was achieved in 96.00% (24/25) patients, the other was died of hypovolemic shock after second session of PAE. Of the 23 patients with long-term follow-up, 23 (100%) restarted regular menstruation, and 4 became pregnant. Univariate analysis showed that caesarean section delivery, associated disseminated intravascular coagulation (DIC), and massive transfusion more than 10 red blood cell units were related to a high rate of clinical failure. Multivariate analysis showed that associated DIC and massive transfusion were significantly related to clinical failure. ConclusionsPAE for primary PPH is safe and effective, with bleeding control successfully after PAE observed in 96.00% of patients. Patients with associated DIC and massive transfusion were likely to need careful observation after PAE.