论文部分内容阅读
目的探讨经导管动脉栓塞术(TAE)治疗难治性妇产科出血的疗效及安全性。方法妇产科难治性出血13例,其中剖宫产术后出血2例,自然产后出血1例,前置胎盘出血4例(人工流产术后3例,术前出血1例),妇科肿瘤术后出血6例(恶性肿瘤5例,良性肿瘤1例)。选择性插管至双侧子宫动脉或髂内动脉,行数字减影血管造影(DSA)明确出血原因、部位后,以直径1～3mm明胶海绵颗粒及明胶海绵条或聚乙烯醇(PVA)栓塞。结果插管成功率100%,12例术后立即无活动性出血,手术成功,1～3天后阴道内完全无流血;1例卵巢癌盆腔转移术后大出血病例,术后仍有出血,又行2次TAE后出血停止。结论TAE创伤小,疗效快速肯定,且并发症少,又可多次应用,对难治性和危及生命的妇产科出血是一种有效的治疗措施,对出血风险高的病例还可预防性应用。
Objective To investigate the efficacy and safety of transcatheter arterial chemoembolization (TAE) in refractory obstetrics and gynecology. Methods Thirteen patients with intractable hemorrhage in obstetrics and gynecology were included. Among them, 2 were bleeding after cesarean section, 1 was natural postpartum hemorrhage, 4 were placenta previa (3 after induced abortion and 1 was preoperative bleeding) Postoperative bleeding in 6 cases (5 cases of malignant tumors, benign tumors in 1 case). After selective catheterization to the bilateral uterine artery or internal iliac artery, digital subtraction angiography (DSA) was performed to identify the cause of hemorrhage. After the site was covered with gelatin sponge particles of 1 to 3 mm in diameter and gelatin sponge strips or polyvinyl alcohol (PVA) embolization . Results The success rate of intubation was 100%, 12 patients had no active bleeding immediately after operation, and the operation was successful. There was no vaginal bleeding after 1 ~ 3 days. One case of hemorrhage after pelvic metastasis of ovarian cancer still had hemorrhage after operation Bleeding stopped after 2 TAEs. Conclusions TAE has a small trauma and quick and definite curative effect with few complications and multiple applications. It is an effective treatment for refractory and life-threatening obstetrics and gynecology bleeding, and is also predictive for the patients with high bleeding risk application.