双侧子宫动脉栓塞术在产后出血防治中的价值

目的 探讨双侧子宫动脉栓塞术在产后出血防治中的作用.方法 27例有产后出血高危因素患者（预防组）和36例已经发生难治性产后出血患者（治疗组）均行双侧子宫动脉栓塞术,观察患者的疗效和不良反应等.结果 预防组患者采用子宫动脉栓塞术后按常规依沙吖啶羊膜腔内注射引产,均经阴道分娩,出血量200～ 480 ml,平均385 ml,无一例发生产后出血.治疗组患者在栓塞前已发生产后出血,出血量1 000～4 200 ml,平均2 050ml,辅助行宫腔填纱9例,背带缝合2例.栓塞术后35例有效,成功率为97.2％（35/36）,无效1例行子宫切除.患者均存活,无一例发生静脉血栓、下肢坏死及感染;所有患者术后子宫复旧良好.产后42 d门诊复查,无一例发生晚期产后出血、产褥感染、席汉综合征.已随访到的53例患者月经恢复时间为3～ 13个月.结论 双侧子宫动脉栓塞术安全、有效、不良反应小,是治疗各种原因导致的难治性产后出血的有效方法;对有产后大出血高危因素的患者也有预防作用.

The function of bilateral uterine artery embolization in the prevention of postpartum hemorrhage

Objective To investigate the effect of bilateral uterine artery embolization in the prevention of postpartum hemorrhage. Methods Twenty-seven patients with risk factors of postpartum hemorrhage （prevention group） and 36 patients with postpartum hemorrhage refractory tendency （treatment group） were underwent bilateral uterine artery embolization. The clinical efficacy and side effects were observed. Results The patients in prevention group were given bilateral uterine artery embolization and conventional induction by ethacridine. All of them finished vaginal delivery, postpartum hemorrhage was 200 -480 ml, average 385 ml, no case of postpartum hemorrhage. The patients in treatment group occurred intractable postpartum hemorrhage before bilateral uterine artery embolization, the amount of hemorrhage was 1 000 - 4 200 ml , average 2 050 ml. Among them, 9 patients were given carbasus to stuff cavitary uteri, 2 patients were given striped-back saturation. Effective in 35 patients, the successful rate was 97.2% （35/36）. One patient was performed with hysterectomy because of inefficient treatment. None occurred maternal deaths ,inefficient and necrosis of lower limbs. All of patients had entire involution of uterus. Reviewed at clinic service after delivery, none occurred postpartum hemorrhage, puerperal infection,Sheehan＇ s syndrome. The menstrual recovery time was 3 -13 months for 53 patients who were followed up. Conclusions Bilateral uterine artery embolization have advantage such as safe, effective,less side effects, and is an effective method for the treatment of various causes of intractable postpartum hemorrhage. It is worthy of clinical application on the prevention of postpartum hemorrhage.