急诊超选择性子宫动脉栓塞术治疗妇产科大出血（附13例报告）

目的 :评价急诊超选择性子宫动脉栓塞术在治疗妇产科大出血中的应用价值。材料和方法 :13例患者 ,其中剖宫产术后出血 7例 ,人工流产术后出血 3例 ,宫颈妊娠 1例 ,侵袭性葡萄胎 1例 ,宫颈癌放疗后外伤出血 1例。 13例均实施急诊超选择性子宫动脉栓塞术 ,栓塞物质为明胶海绵和弹簧钢圈 ,2例术中并行子宫动脉化疗药物灌注。结果 :栓塞术后所有病例立即无活动性出血 ,12例成功 ,1～ 3天后阴道内完全无流血 ;1例失败 ,栓塞术后 2 0min再次出现阴道内大量流血而行急诊手术治疗。所有病例均未发生严重并发症。结论 :急诊超选择性子宫动脉栓塞术快速、安全、微创、可靠、有效且并发症少 ,又可多次应用 ,应该作为治疗妇产科大出血的首选方法 ;并且一般不会影响患者的生育功能 ,值得推广应用。

Uterial Arterial Embolization for Control of Gynecological and Obstetric Hemorrhage (A Report of 13 Cases)

Purpose: To evaluate the efficacy and value of emergent super selective uterine arterial embolization in the treatment of gynecological and obstetrical bleeding. Materials and Methods: 13 cases with serious gynecological and obstetrical hemorrhage including post cesarean section(n=7),artificial abortion (n=3),ectopic pregnancy(n=1),trophoblastic disease(n=1) and cervix cancer traumatic bleeding(n=1), were treated by super selective arterial embolization with gelfoam particles and coils. Results: The bleeding was successfully controlled by embolization in all cases,only 1 case bled again after the embolism 20 minutes. No serious complication happened. Conclusion: Emergent super selective uterine arterial embolization is rapid,safe,relatively noninvasive,reliable and effective method,its complication is rare and fertility of the patient can also be preserved. Transcatheter arterial embolization should be the first choice for gynecological and obstetrical bleeding.