数字减影血管造影引导下聚乙烯醇栓塞颗粒联合弹簧钢圈行髂内动脉及其分支主干栓塞在妇产科大出血救治中的应用

目的:探究数字减影血管造影(DSA)引导下聚乙烯醇栓塞颗粒(PVA)联合弹簧钢圈行髂内动脉及其分支主干栓塞在妇产科大出血救治中的应用。方法:选取医院收治的40例妇科大出血患者,依据出血量将其分为早期组(24例,出血量≤1000 ml)和晚期组(16例,出血量>1000 ml)。采用Seldinger技术插管至髂内动脉行DSA造影,寻找出血血管,用PVA颗粒联合弹簧钢圈栓塞出血血管,并观察患者术后止血情况以及不良反应发生情况。结果:所有患者均在DSA引导下完成PVA联合弹簧钢圈栓塞止血治疗,栓塞后造影均无造影剂外溢情况,止血成功率为100%,术后未发生严重不良反应。早期组平均出血量、输血总量以及平均出血时间明显低于晚期组,差异有统计学意义(t=28.624,t=3.573,t=25.546;P<0.05);早期组不良反应总发生率(4.16%)显著低于晚期组(12.50%),差异有统计学意义(x²=7.548,P<0.05)。结论:DSA引导下PVA联合弹簧钢圈髂内动脉及其分支栓塞在妇产科大出血救治中止血效果好,早期应用于治疗妇产科大出血能降低不良反应发生。

Application of undergoing embolization in internal iliac artery and its main branch by using DSA-guided PVA embolization particle combined with spring steel coil in treatment and cure of massive hemorrhage of gynecology and obstetrics

Objective:To investigate the application of undergoing embolization in internal iliac artery and its main branch by using digital subtraction angiography(DSA)-guided polyvinyl alcohol(PVA)embolization particle combined with spring steel coils in treatment and cure of massive hemorrhage of gynecology and obstetrics.Methods:40 patients with massive hemorrhage of gynecology and obstetrics were selected,and they were divided into the early stage group(24 cases,the amount of bleeding≤1000 ml)and end-stage group(16 cases,the amount of bleeding>1000 ml).Seldinger technique was used to intubate in the internal iliac artery for undergoing DSA so as to find the bleeding vessels,and PVA particles were used to combine with spring steel coil for the embolization of bleeding vessels.And then,the occurrences of postoperative hemostasis situation and adverse reaction of patients were further observed.Results:Under the guidance of DSA,40 patients were treated by the hemostasis method with embolization of PVA particle combined with spring steel coil.In the angiography post embolization,there was no occurrence of the leakage of contrast medium,and the success rate of hemostasis was 100%.No serious adverse reactions occurred after surgery.The average amount of bleeding,the total amount of blood transfusion and the average time of bleeding in early stage group were significantly lower than those in end-stage group(t=28.624,t=3.573,t=25.546,P<0.05).The total incidence of adverse reactions in early stage group(4.16%)was significantly lower than that in end-stage group(12.50%)(x2=7.548,P<0.05).Conclusion:The application of the embolization with DSA-guided PVA combined with spring steel coil in internal iliac artery and its main branches has a favorable hemostatic effect in the treatment and cure of massive hemorrhage of gynecology and obstetrics.Early application of this method in the treatment of massive hemorrhage of gynecology and obstetrics can reduce the incidence of adverse reactions.