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动脉栓塞治疗软产道损伤致难治性产后出血

Arterial embolization in the treatment of intractable postpartum hemorrhage caused by soft birth canal injury

  • 摘要: 目的:探讨盆腔动脉栓塞术(PAE)治疗软产道损伤致难治性产后出血的有效性及安全性。方法:收集北京积水潭医院2014年1月至2017年12月软产道损伤致难治性产后出血接受PAE治疗的患者的临床资料,分析出血原因及PAE的治疗效果。结果:软产道损伤致难治性产后出血8例,占我院难治性产后出血的42%。8例患者中,4例阴道分娩、4例剖宫产。6例患者术前进行了阴道壁血肿清除术。8例患者术前均采用了促宫缩药物。8例患者共栓塞了19根动脉,其中双侧子宫动脉6例,右侧阴部内动脉+双侧子宫动脉1例,双侧子宫动脉+双侧髂内动脉主干1例。8例患者均技术成功和临床成功。2例术后出现轻度发热。8例患者均保留子宫,均恢复规律月经,其中7例患者经量无明显改变,1例患者经量减少。结论:PAE用于治疗软产道损伤致难治性产后出血疗效确切、安全微创,可作为其保守治疗后的一线治疗方案。

     

    Abstract: Objective:To investigate the efficacy and safety of pelvic artery embolization (PAE) in the treatment of intractable postpartum hemorrhage caused by soft birth canal injury. Methods:Clinical data of patients with refractory postpartum hemorrhage due to soft birth canal injury and receiving PAE from January 2014 to December 2017 in Beijing Jishuitan Hospital were collected. The hemorrhage reasons and efficacyof PAE for the disease were analyzed. Results:8 cases of refractory postpartum hemorrhage caused by soft birth canal injury accounted for 42% of refractory postpartum hemorrhage in our hospital. Of the 8 patients, 4 had vaginal delivery and 4 had cesarean delivery. 6 patients underwent vaginal wall hematoma removal before surgery. 8 patients were treated with uterine contractions before surgery. A total of 19 arteries were embolized in 8 patients, including 6 bilateral uterine arteries, 1 right pudendal artery and 2 bilateral uterine arteries, and 2 bilateral uterine arteries and 2 internal iliac artery trunks. Outcomes of the 8 patients were technically and clinically successful. 2 patients developed mild fever after surgery. All the 8 patients retained the uterus, and all of them recovered regular menstruation. Among them, 7 patients had no significant changes in the amount of menstruation, and 1 patient had decreased menstrual volume. Conclusions:PAE is effective in the treatment of refractory postpartum hemorrhage caused by soft birth canal injury. It is safe and minimally invasive, and could be the firstline treatment after conservative treatment.

     

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