髂内动脉栓塞治疗产后大出血

目的探讨髂内动脉栓塞治疗产后大出血的疗效与安全性。方法用弹簧圈或(和)明胶海绵对18例产后大出血患者行髂内动脉栓塞。栓塞后4～26个月,对5例患者用16排螺旋CT盆腔扫描并行动脉血管重建,8例患者行雌二醇(E2)、促卵泡激素(FSH)、黄体生成素(LH)、泌乳素(PRL)等激素检查。结果明胶海绵栓塞者栓塞远端动脉完全开放。钢圈加明胶海绵栓塞后可出现两种情况:一是子宫以卵巢动脉供血为主,部分开放的子宫动脉供血为辅;二是子宫仍以开放的子宫动脉供血为主。8例患者激素检查均为正常,2例再妊娠,未出现严重并发症。结论髂内动脉栓塞治疗产后大出血是安全有效的。

Treatment of postpartum severe hemorrhage with selective internal iliac artery embolization

Objective To discuss the effectiveness and safety of selective iliac artery embolization in treating severe postpartum hemorrhage.Methods Eighteen cases of postpartum severe hemorrhage were treated by embolizing iliac artery with gelatin and/or steel coil.4-26 months later,5 cases were scanned with 16 layer MD(multi-detector)spiral CT with pelvic artery reconstruction and hormones(E2?P?T?FSH?LH?PRL)examination taken in 8 cases.Results Arteries were re-opened in cases embolized with gelatin.Two possible results may occur in those embolized with steel coil including one with uterus mainly supplied by ovarian arterian assisted by re-opened uterus artery and the other mainly fed by re-opened uterus artery.Hormones of the 8 cases were normal.Two women got re-pregnant after embolization.No serious complication related to embolization was found.Conclusion Iliac arterial embolization is safe and effective for the control of severe postpartum hemorrhage.(J Intervent Radiol,2006,15:218-220)