【作者】 李小松；

【导师】 辜斌；

【作者基本信息】 南昌大学 ， 影像医学与核医学， 2008， 硕士

【摘要】 目的:通过对经导管动脉栓塞术及子宫切除术这两种不同治疗方法在难治性产后出血中的临床对比分析,探讨经导管动脉栓塞术在难治性产后出血中的应用价值。方法:对2004年9月～2007年11月在南昌大学第一附属医院产科治疗的38例难治性产后出血患者进行回顾性分析,其中顺产31例,剖宫产7例。按照止血方式不同分为两组,研究组20例,年龄21～37岁,平均年龄(27.10±3.91)岁,均采用右股动脉Seidinger穿刺技术,用5FCobra导管及0.035英寸导引导丝,选择性插管至髂内动脉或子宫动脉,行数字减影血管造影明确出血部位后,用明胶海绵颗粒行两侧髂内动脉或子宫动脉栓塞术;对照组18例,年龄22～35岁,平均年龄(28.11±3.72)岁,行子宫切除术,包括子宫全切及次全切除术。并从止血有效率、手术时间、术后下床活动时间及术后住院天数几方面进行对比分析。结果:1、研究组20例栓塞成功,1例因术后6h出血转行子宫次全切除术,研究组止血有效率为95%;对照组止血有效率为94.4%,二组比较,差异无统计学意义(P=0.73)。2、研究组手术时间、术后下床活动时间、术后住院天数分别为(48.80±9.92)min、(3.10±1.12)d、(8.45±2.01)d;对照手术时间、术后下床活动时间、术后住院天数分别为(84.22±8.76)min、(4.33±1.19)d、(13.11±2.28)d,研究组明显短于对照组,差异有统计学意义(P值分别为P<0.01、P=0.01、P<0.01)。研究组与对照组子宫切除率分别为5%、100%,研究组明显少于对照组。3、研究组19例随访9个月,其中15例月经恢复正常,且有1例再次妊娠并顺利分娩。结论:1、在难治性产后出血治疗中,经动脉导管栓塞术与子宫切除术止血效果无区别,两种方法都有效。2、经动脉导管栓塞术与子宫切除术比较,具有创伤小、痛苦少、恢复快、住院时间短、可保留子宫及生育能力等优点。3、经动脉导管栓塞术为难治性产后出血的治疗提供了一种新方法,有条件的医院值得推广应用。但是经动脉导管栓塞术仍无法取代子宫切除术。更多还原

【Abstract】 Objective: To evaluate the clinical value of transcatheter arterial embolization in the treatment of intractable postpartum hemorrhage compared with hysterectomy. Methods: Clinical data of 38 patients with intractable postpartum hemorrhage including 31 cases with spontaneous postpartum and 7 cases with postcesarean bleeding hospitalized from September 2004 to November 2007 in the First affiliated hospital of Nanchang University were retrospectively analyzed.All patients were divided into two groups by different hemostasia ways, research group underwent femoral artery puncture by Seldinger,s technique,the age of the patients ranged between 21 and 37 years with a mean age of (27.10±3.91) years and the number was 20,a 5F Cobra catheter was used with a hydrophilic polymer-coated 0.035 inch guidedwire, superselectiv catheterization to the bilateral internal iliac arteries or uterial arterial and internal iliac arteries embolization(IIAE) or uterial arterial embolization(UAE) with gelfoam particles was followed after the bleeding sources was proved by digital substraction angiography(DSA) techniques; control group was treated by hysterectomy including total hysterectomy and supercervical hysterectomy,the age of the patients ranged between 22 and 35 years with a mean age of (28.11±3.72) years and the number was 18.The following items were investigated: the effective power of haemostasis、operating time、stayearlier out-of-bed activity and median postoperative hospital.Results:1、Twenty cases in research group were performed successfully while a conversion to hysterectomy was required in one case because of bleeding on the secong day after operation. effective power of haemostasis was 95% in research group,which was 94.4% in control group, comparison between two group showned that difference had not statistical significance(P=0.73).2、Operation time、earlier out-of-bed activity and median postoperative hospital stay in research group were (48.80±9.92)min、(3.10±1.12)d、(8.45±2.01)d respectively, those were (84.22±8.76)min、(4.33±1.19)d、(13.11±2.28)d respectively in control group, research group was significantly shoter than control group, the difference had statistical significance(P<0.01、P=0.01、P<0.01). Hysterectomia rate was 5% in research group, which was 100% in control group, research group was significantly less than control group,3、Nineteen patients were followed up for nine months in research group, fifteen women resumed normal menstruation,moreover one woman got re-pregnant and successfully given birth to a child.Conclusion:1、The clinical effect has not defferent between transcatheter arterial embolization and hysterectomy in the treatment of intractable postpartum hemorrhage and two treated methods were all effective2、Compared to hysterectomy, transcatheter arterial embolization has many advantages including minimal trauma、less postoperative dysfunction、shorter hospital stay and Uterus and its physiological function were reserved.3、Transcatheter arterial embolization is a new way to the treatment of intractable postpartum hemorrhage,it deserves to spread and utilize in the conditioned hospital. But sometimes hysterectomy is still required.更多还原