急诊动脉栓塞术在产后出血中的应用

目的　评价急诊经导管动脉栓塞术 (TAE)治疗难治性产后出血的疗效及安全性。方法　 18例难治性产后出血选择性插管至双侧髂内动脉或子宫动脉 ,行数字减影血管造影 (DSA)明确出血原因、部位后 ,以直径 1～ 3mm明胶海绵颗粒栓塞。结果　插管成功率 10 0 % ,手术时间 3 0～ 60min ,平均 ( 4 5 .2± 4.8)min ,术后止血总有效率 10 0 %。术后随访 3～ 40个月 ,均无严重并发症发生 ,所有患者宫体按期复旧 ,转经后月经正常。结论　TAE创伤小 ,疗效快速肯定 ,术后短期及长期随访无严重并发症 ,对危及生命的产后出血是一种有效的治疗措施

Application of urgent transcatheter arterial embolization in intractable postpartum hemorrhage

Objective To investigate the efficacy and safety of emergency transcatheter arterial embolization (TAE) in the management of intractable postpartum hemorrhage. Methods Eighteen women with intractable postpartum hemorrhage underwent superselective catheterization to the bilateral internal iliac arteries or uterial arterial, and the TAE with gelfoam particles soaked in the Gentamycin sulfate was followed after the bleeding sources and causes was proved. Results Obstetrical bleeding were successfully controlled in all the 18 patients. The operation time of TAE lasted from 30 to 60 minutes, mean 45.2±4.8 minutes. Digital subtraction angiography showed diffuse extravasation of contrast agent in10 cases, bleeding from 4 vaginal arteries, 3 uterus arteries and one pudendal artery. All patients were followed up for 3 to 40 months. No severe complication of TAE occured. Menstruation resumed in all patients. Conclusion Emergency TAE is a safe and effective method in the control of intactable postpartum hemorrhage.