剖宫产术后大出血的造影表现及介入治疗

目的探讨剖宫产术后大出血的造影表现及子宫动脉栓塞术治疗剖宫产术后大出血的临床疗效。 方法收集26例剖宫产术后大出血患者资料，出血量500～2500 ml。局麻下经股动脉穿刺，将4F Cobra导管选择至双侧子宫动脉，用自制的明胶海绵颗粒将子宫动脉分支栓塞，最后用明胶海绵块（条）栓塞子宫动脉主干。栓塞满意后，将导管退出子宫动脉至髂内动脉造影，证实栓塞完全。 结果患者均一次性插管成功，其中25例患者成功止血，栓塞后48 h内出血停止，血红蛋白（HGB）术前与术后分别为(65.3±7.4)g/L和（83.5±5.6）g/L，差别有统计学意义(P<0.01)，无严重并发症发生。患者子宫动脉栓塞术后至康复出院的时间为1～8天，平均(3.9±2.2)天。 结论子宫动脉栓塞术治疗剖宫产术后出血，创伤小，成功率高，并发症少，住院时间短，大大降低了医疗风险，值得临床推广。

Angiography performance and intervention therapy of hemorrhage after cesarean section

ObjectiveTo evaluate angiography performance of hemorrhage after cesarean section and clinical efficacy of uterine artery embolization for bleeding after cesarean section. MethodsData of 26 patients with cesarean section bleeding, their bleeding was from 500 ml to 2500 ml. 4F Cobra catheter were selected to the uterine artery through the femoral artery puncture under local anesthesia. Gelatin sponge particles were used to embolize uterine artery branches And Gelatin sponge bricks/sticks were used to embolize uterine artery. After embolization, the catheter was selected to the internal iliac for angiography to confirmed embolizing successfully. ResultsThe patients were one-time intubation success. Twenty-five patients stop bleeding after embolization in 48 h. The preoperative and postoperative hemoglobin (HGB) were (65.3±7.4)g/L and (83.5±5.6)g/L, there was no statistical different between the two (P<0.01) and no serious complications. Patients with uterine artery embolization leave hospital 1—8 days later, average of 3.9±2.2 days. ConclusionUterine artery embolization for hemorrhage after cesarean section is trauma small, high success rate, fewer complications, shorter hospital stay, and greatly reduce the medical risk. It is worthy of wide popularize.