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山东大学学报 (医学版) ›› 2019, Vol. 57 ›› Issue (12): 86-91.doi: 10.6040/j.issn.1671-7554.0.2019.1041

• • 上一篇    

盆腔动脉栓塞术治疗产后出血的临床分析

田宁,陈奕,韩文莉,张晓峰   

  1. 首都医科大学附属北京妇产医院产科, 北京100026
  • 发布日期:2022-09-27
  • 通讯作者: 陈奕. E-mail:bjfcyycy@sina.com

A clinical analysis of pelvic arterial embolization for postpartum hemorrhage

TIAN Ning, CHEN Yi, HAN Wenli, ZHANG Xiaofeng   

  1. Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
  • Published:2022-09-27

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摘要： 目的 探讨盆腔动脉栓塞术(PAE)在治疗产后出血中的临床优势、方法的选择、有效性与安全性。 方法 收集首都医科大学附属北京妇产医院2016年1月至2018年1月期间46例主因产后出血接受PAE治疗患者的临床资料,回顾性分析PAE的临床操作特点、有效性,随访患者的PAE近、远期并发症及再生育结局。 结果 46例患者中,24例阴道分娩,22例剖宫产分娩,产后出血的原因主要为胎盘因素(63.04%),其次为宫缩乏力(52.17%)、子宫动静脉畸形(8.70%)、软产道裂伤(4.35%),同时存在多种因素导致的产后出血共8例。全部46例患者在PAE前均进行了一种或多种干预措施,效果不佳而行PAE治疗。46例患者共栓塞了133根动脉,其中单纯栓塞双侧子宫动脉27例次(其中3例患者各进行2例次),单纯栓塞双侧髂内动脉1例,栓塞双侧子宫动脉并双侧髂内动脉15例,栓塞双侧腹壁下动脉1例,栓塞双侧卵巢动脉1例,栓塞双侧子宫动脉+双侧髂内动脉+右侧卵巢动脉1例。46例患者共进行了51次PAE,均达到了技术成功,技术成功率100%(51/51);46例患者中有3例患者PAE 后出血未得到有效缓解,进行了2次PAE后出血止,1例患者间断进行了3次PAE后止血成功,1例患者PAE失败后行子宫切除术,临床成功率为88.23%(45/51)。46例患者6例发生PAE后发热,随访的42例患者中,39例(92.86%)恢复了月经,3例(7.14%)闭经,7例(16.67%)再次妊娠。 结论 PAE治疗产后出血疗效确切且安全。

关键词: 产后出血, 凶险性前置胎盘, 盆腔动脉栓塞, 治疗结果

Abstract: Objective To evaluate the clinical advantages, method selection, efficacy and safety of pelvic arterial embolization(PAE)in the treatment of postpartum hemorrhage(PPH). Methods Clinical data of 46 PPH cases who received PAE in our hospital during Jan. 2016 and Jan. 2018 were retrospectively analyzed. The clinical operating characteristics and effectiveness of PAE, short- and long-term complications and re-fertility outcomes were evaluated. Results Among the 46 cases,24 had virginal delivery and 22 received cesarean section.The most frequent cause of PPH was placental problems(63.04%), followed by uterine atony(52.17%), uterine arteriovenous malformation(8.70%), and genital tract trauma(4.35%). Eight cases had combined causes. All 46 patients received one or more interventions before PAE, and PAE was performed when these interventions failed. Altogether 133 arteries received PAE, including bilateral uterine arteries in 27 cases, bilateral internal iliac arteries in 1 case, bilateral uterine arteries and bilateral iliac arteries in15 cases, bilateral inferior epigastric arteries in 1 case,bilateral ovarian arteries in 1 case, and bilateral uterine arteries, bilateral internal iliac arteries, and right ovarian artery in 1 case. Altogether 51 PAE were performed, and the overall technical success rate was 100%(51/51). Of all 46 patients, 3 had no effective relief after the first PAEand had to receive asecond one; 1 received 3 consecutive PAE; 1 received hysterectomy after PAE failed. The clinical success rate was 88.23%(45/51). Fever occurred in 6 patients after PAE. Of the 42 patients who were followed up, 39(92.86%)resumed normal menses, 3(7.14%)reported amenorrhea, and 7(16.67%)had pregnancy again. Conclusion PAE is effective and safe in the treatment of postpartum hemorrhage.

Key words: Postpartum hemorrhage, Pernicious placenta previa, Pelvic arterial embolization, Treatment outcome

中图分类号: 

  • R714.7
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