子宫动脉造影和栓塞治疗在妇产科大出血中的临床应用.docVIP

子宫动脉造影和栓塞治疗在妇产科大出血中的临床应用 作者：邱水波,周汝明,刘闽华,吴育民,陈奇 单位：广东省深圳市第二人民医院放射科， 广东 深圳 【摘要】目的 探讨妇产科大出血的动脉造影表现和栓塞治疗的疗效及临床价值。 方法 对18例妇产科大出血的患者，包括子宫颈妊娠5例，产后宫缩乏力3例，前置胎盘1例，粘膜下子宫肌瘤3例，绒癌2例，子宫颈癌2例，次全子宫切除术后出血1例，巨大子宫内膜息肉1例，所有病例行双侧子宫动脉造影，并用聚乙烯醇微粒+明胶海绵颗粒进行栓塞治疗。 结果 18例患者双侧子宫动脉超选择插管成功，其中12例造影见活动性出血征象，13例于实质部见大片状不规则染色,所有病例均成功行双侧子宫动脉栓塞，出血立即停止或明显减少，经扩容、输血等支持疗法后血压回升，血红蛋白上升，生命体征稳定，观察2周内无再出血发生，无严重并发症。 结论 子宫动脉造影及栓塞治疗是妇产科大出血安全有效的诊断和治疗方法。 【关键词】 妇产科出血；动脉造影；诊断；栓塞，治疗性 The clinical application of uterine arteriography and embolization to gynecological massive hemorrhage QIU Shui-bo, ZHOU Ru-ming, LIU Min-hua, et al. Department of Radiology, the Second Peoplersquo;s Hospital of Shenzhen, Guangdong 518035,China [Abstract］ Objective To evaluate the manifestations of arteriography and the effect of embolization on the gynecological massive hemorrhage. Methods Bilateral angiography on uterine arteries was performed on 18 cases with gynecological massive hemorrhage, including 5 cases with cervical pregnancy, 3 cases with postpartum uterushypokinesia, 1 case with placenta previa, 3 cases with uterine leiomyomas, 2 cases with choriocarcinoma, 2 cases with cervical cacinoma, 1 cases with semi-ablation on uterine, 1 case with massive endometriumpolypus. And embolization with polyvinyl alcohol and gelfoams particles were used for the treatment. Results The bilateral superselective intubation to uterine arteries succeeded in 18 cases, among which active hemorrhage was in 12 cases, the big and irregular essential stains in 13 cases. The bilateral embolization to uterine arteries succeeded in 18 cases, which resulted in hemorrhage termination or obvious decrease. After enlarging the circular cubage and transfusing blood, the blood pressure and haemoglobin were raised. The life signs were stable. All cases had no re-bleeding within two weeks. No severe complications were observed. Conclusion The angiography of uterine arteries and embolization were safe and effective in the diagnosis and therapy of gynecological mass