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目的探讨难治性产后出血应用宫腔填纱、经导管行子宫动脉栓塞术(transcatheter arterial embolization,TAE)及子宫切除术治疗的临床效果及合理应用价值。方法回顾性分析鄂州市妇幼保健院妇产科2011~2014年收治的57例难治性产后出血患者的临床资料,根据不同治疗方式分为宫腔填纱组(29例)和TAE组(28例),其中两种治疗均失败采用子宫切除术9例,分析其治疗效果。结果两组患者的主要诱发因素均为产程延长或停滞、妊娠期高血压疾病、巨大儿,两组诱发因素构成、手术时间比较差异无统计学意义(P>0.05)。TAE组的止血时间(6.4±3.2)min、术后出血量(43.5±6.7)m L、总出血量(1 865.2±309.5)m L、术后下床活动时间(3.5±1.2)d、住院时间(8.7±2.5)d均低于宫腔填纱组[(32.5±9.3)min、(224.7±78.9)m L、(2 094.9±372.8)m L、(5.2±3.3)d、(10.1±2.7)d](P<0.05);宫腔填纱组患者于术后(25.5±4.0)h取出纱条。宫腔填纱组成功止血21例(72.41%),止血失败8例(27.59%),TAE组成功止血27例(96.43%),治疗失败1例(3.57%),TAE组治疗成功率高于宫腔填纱组(P<0.05)。两组止血失败9例均紧急采用子宫切除术治疗成功。结论对于难治性产后出血患者应及时予以止血处理,在保留子宫的前提下TAE止血效果优于宫腔填纱治疗,当上述两种方式无效的时候应及时采取子宫切除手术治疗,以达到抢救患者生命的目的。
Objective To investigate the clinical effect and reasonable value of intrauterine filling, transcatheter arterial embolization (TAE) and hysterectomy in refractory postpartum hemorrhage. Methods The clinical data of 57 patients with refractory postpartum hemorrhage admitted in the obstetrics and gynecology department of Ezhou Maternal and Child Health Hospital from 2011 to 2014 were retrospectively analyzed. According to the different treatment methods, they were divided into two groups: the uterine filling group (29 cases) and the TAE group (28 cases) Cases), of which two treatments failed hysterectomy in 9 cases, analysis of its therapeutic effect. Results The main inducing factors in both groups were prolonged or stagnated labor, hypertensive disorder complicating pregnancy, macrosomia and inducing factors in both groups. There was no significant difference in operative time between the two groups (P> 0.05). The bleeding time (6.4 ± 3.2) min, postoperative bleeding volume (43.5 ± 6.7) m L, total blood loss (1865.2 ± 309.5) m L and postoperative ambulation time (3.5 ± 1.2) days were significantly higher in TAE group The mean time to treatment was (8.7 ± 2.5) days, lower than those in the uterine filling group [(32.5 ± 9.3) min, (224.7 ± 78.9) m L, (2094.9 ± 372.8) m L, 2.7) d] (P <0.05). In the uterine filling group, the sliver was removed after 25.5 ± 4.0 h. Among them, 21 cases (72.41%) successfully failed to hemostasis, 8 cases (27.59%) failed to stop bleeding, 27 cases (96.43%) succeeded in TAE, one case failed to cure (3.57%), the success rate of TAE was higher than Uterine filling group (P <0.05). Nine cases of failed hemostasis in both groups were successfully treated with hysterectomy. Conclusion For patients with refractory postpartum hemorrhage hemostasis should be promptly treated in the premise of retaining the uterus TAE hemostatic effect is better than uterine filling, when the above two methods should be taken promptly hysterectomy surgery in order to achieve the rescue The purpose of the patient’s life.