子宫动脉栓塞联合手术在预防妇产科出血性疾病中的应用

目的 探讨子宫动脉栓塞联合手术在预防妇产科出血性疾病中的应用价值.方法 选取2013年5月～2014年5月本院收治的妇产科疾病行子宫动脉栓塞的住院患者40例,其中行预防性子宫动脉拴塞术的28例为研究组（剖宫产瘢痕妊娠25例,宫颈妊娠1例,中期引产并前置胎盘2例）,行子宫动脉拴塞术控制急性大出血的12例为对照组（产后出血5例,中期引产出血2例,剖宫产瘢痕妊娠出血4例,阴道壁囊肿术后出血1例）.对40例患者行血管造影并采用明胶海绵颗粒选择性栓塞子宫动脉,或栓塞前子宫动脉灌注甲氨蝶呤;栓塞后根据病情进行手术治疗.比较两组栓塞前后出血量、住院天数、住院费用、输血率、休克率及并发症等.结果 40例患者行超选择子宫动脉栓塞,1例同时栓塞阴部内动脉,17例栓塞前子宫动脉灌注甲氨蝶呤杀胚胎治疗,所有患者均栓塞成功;术后1～9 d内行刮宫术（B超或宫腔镜下）,或病灶清除术（腹式、腹腔镜下、阴式）,或剖宫产术.两组无严重并发症及子宫切除发生;研究组栓塞前出血量、输血率、休克率明显低于对照组（P＜0.01）,住院费用少于对照组（P＜0.05）.结论 预防性子宫动脉栓塞联合手术可减少妇产科手术中出血,减少并发症发生,是一种安全、微创和有效的治疗方法.

The application of uterine arterial embolism combined with operation in prevention of obstetrics and gynecology hemorrhagic disease

Objective To investigate the application value of uterine arterial embolism （UAE） combined with operation in prevention of obstetrics and gynecology hemorrhagic disease. Methods 40 cases of patients with obstetrical and gynecological diseases carried out uterus artery embolism in our hospital from May 2013 to May 2014 were selected,of whom,28 patients （25 cases of cesarean scar pregnancy,1 case of cervical pregnancy,2 cases of mid-pregnancy induced labor combined with placenta previa） carried out preventive uterine arterial embolism were as the study group,12 patients （5 patients with postpartum hemorrhage,2 patients with induced labor of middle bleeding,4 patients with cesarean scar pregnancy hemorrhage and 1 patient with vaginal wall cyst postoperative bleeding） carried out uterine arterial embolism to control acute bleeding were as control group.Angiography combined with selective embolization uterine arterial using gelatin sponge particles or perfusion methotrexate to uterine artery before embolization were taken to 40 cases of patietns.Surgery was taken after embolization according to the disease.Blood loss before and after embolization,hospitalization days,hospitalized expense,blood transfusion rate,shock rate and complications were compared between the two groups. Results 40 cases of patients were given with selective uterine arterial embolism,embolization vaginal inside arteries was taken to 1 patient at the same time,perfusion methotrexate to uterine artery for killing embryos treatment before embolization was taken to 17 patients,all patients were successful embolization;1-9 days after operation were given with dilatation and curettage of uterine （by B-ultrasound or hysteroscopy） or focus clearance （transabdominal la- paroscopy transvaginal） or cesarean section.Two groups had no serious complications and hysterectomy.The bleeding volume before embolization,blood transfusion rate,shock rate in study group were lower than those of control group （P〈 0.01）;and hospitalization cost