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目的 评估重度产后出血介入治疗的安全性。 方法 对 18例经保守治疗无效的重度产后出血患者行介入治疗 (经皮双髂内动脉或子宫动脉栓塞术 ) ,从手术时间、治疗效果、侧支循环的建立、栓塞术后宫体肌层病理变化及术中卵巢 X线负荷量等的角度 ,探讨重度产后出血介入治疗的安全性。 结果 (1) 18例患者均一次止血成功 ,止血时间 3~ 10 m in,平均时间 (6± 4) m in,手术时间 30~ 5 0 min,平均 (39± 5 ) min;(2 )介入治疗后虽然栓塞了双髂内动脉或子宫动脉 ,但仍有卵巢动脉、腹壁下动脉等向子宫供应少量的血流 ;(3) 3例患者于术后 5~ 10 d行宫体穿刺活检 ,病理显示 :子宫体肌层呈散在的、非连续性凝固性坏死 ,范围不超过肌层的 1/4 ,临床未见术后子宫坏死的病例 ;(4 )监测 5例患者术中卵巢所受 X线辐射量为 (17± 7) c Gy,在正常允许耐受量范围内。 结论 重度产后出血行介入治疗是安全的
Objective To evaluate the safety of interventional treatment of severe postpartum hemorrhage. Methods 18 cases of severe postpartum hemorrhage with conservative treatment were treated with interventional therapy (percutaneous double internal iliac artery or uterine artery embolization). From the time of operation, the therapeutic effect, the establishment of collateral circulation, Pathological changes and intraoperative ovarian X-ray load from the point of view, to discuss the safety of interventional treatment of severe postpartum hemorrhage. Results (1) The hemostasis was successful in all of the 18 patients. The mean time of hemostasis was 3 ~ 10 mins and the average time was (6 ± 4) m in. The mean operative time was 30 ~ 50 min (mean, 39 ± 5) min. Although the embolization of the internal iliac artery or uterine artery after treatment, but there are still ovarian artery, abdominal artery and other small uterine supply of blood flow; (3) 3 patients in 5 to 10 days postoperative uterine biopsy, pathology Showed: the uterine myometrium was scattered, non-continuous coagulation necrosis, the range does not exceed 1/4 of the muscular layer, no case of clinical uterine necrosis; (4) to monitor the 5 cases of patients with intraoperative ovarian X The amount of line radiation was (17 ± 7) c Gy, within the normal tolerable range. Conclusion Interventional treatment of severe postpartum hemorrhage is safe