超选择性子宫动脉栓塞术在剖宫产后大出血中的应用

目的 探讨超选择性子宫动脉栓塞术在行剖宫产术后发生大出血患者中的临床疗效.方法 选择2007年7月～2010年3月行剖宫产术后发生子宫大出血的24例患者,经产科常规方法不能有效控制子宫出血,采用血管内介入技术栓塞子宫动脉止血.结果 22例患者经超选择性插管栓塞子宫动脉后均能有效止血,同时保留了子宫及生理功能,术中术后均未发生并发症.2例患者经血管内介入栓塞后3h内再次发生大出血,1例经再次超选择血管内栓塞后成功止血,1例直接切除子宫.结论 超选择性子宫动脉插管栓塞术是治疗剖宫产术后大出血的有效治疗方法,其具有创伤小、疗效好、止血迅速可靠的特点,能够在挽救产妇生命的同时保留子宫及其生理生育功能,其安全性和疗效均较高,若血管内介入术后不能有效止血,可再次行血管内介入栓塞或者切除子宫.

Application of super selective uterine artery embolization in massive hemorrhage after caesarean section

Objective To discuss the clinical effect of super selective uterine artery embolization in patients with mas- sive hemorrhage after caesarean section. Methods Clinical data of 24 patients who presented with uterus massive hem- orrhage after caesarean section from July 2007 to March 2010 were retrospectively analyzed.If the bleeding couldn＇t be controlled by conventional methods in obstetrical department,then uterine artery embolization for endovascular inter- vention was applied. Rellts The massive hemorrhage was effectively stanched by super selective uterine artery em- bolization in 22 cases and the uterus and its physiological functions were retained simultaneously.There was no compli- cation occurred after endovascular intervention.There was massive hemorrhage occurred again 3 hours after endovascu- lar intervention in 2 cases.The bleeding in one patient was successfully controlled after applying super selective en- dovascular embolization again,and the other one case was completely removed the whole uterus. Conclusion Super se- lective uterine artery embolization,at advantages of small wound,favorable effect,swiftly stanching bleeding, and high safety,is an effective way to treat massive hemorrhage after caesarean section.It can save puerpera＇s life,as well as keep the uterus and physiological fertility functions.When bleeding hasn＇t been stopped by endovascular intervention,the en- dovascular embolization can be applied again or the whole uterus is removed.