盆腔动脉栓塞术治疗难治性产后大出血的临床分析

doi:10.3877/cma.j.issn.2095-5782.2015.03.003

中华介入放射学电子杂志 ›› 2015, Vol. 03 ›› Issue (03) : 123 -128. doi: 10.3877/cma.j.issn.2095-5782.2015.03.003

所属专题：文献；

血管介入

盆腔动脉栓塞术治疗难治性产后大出血的临床分析

曹广劭¹, 刘玉岩¹, 曹会存¹^,^†(

), 刘健¹, 王玉丹¹, 刘瑞青¹, 刘诗义¹, 李辉¹, 李天晓¹

^1. 450003　郑州大学附属人民医院介入科

收稿日期:2015-04-21 出版日期:2015-08-01
通信作者: 曹会存

Clinical analysis of pelvic arterial embolization for treatment of primary postpartum hemorrhage

Guangshao Cao¹, Yuyan Liu¹, Huicun Cao¹^,^†(), Jian Liu¹, Yudan Wang¹, Ruiqing Liu¹, Shiyi Liu¹, Hui Li¹, Tianxiao Li¹

^1. Department of Interventional Radiology, Renmin Hospital of Zhengzhou University, Zhengzhou 450003, China

Received:2015-04-21 Published:2015-08-01
Corresponding author: Huicun Cao
About author:
Corresponding author: Cao Huicun, Email: yajuncao98@126.com

全文 ( ) 下载PDF ( ) 导出引用

目的

讨论盆腔动脉栓塞术（PAE）治疗难治性产后大出血（PPH）的安全性和可行性，并评估影响其临床成功率的因素。

方法

回顾性分析需要做PAE手术的25例难治性PPH患者，分娩方式、出血的病因、详细的生化资料和治疗措施及临床结果都被记录下来，对影响临床结果的各种可能因素进行了单变量及多变量分析。

结果

临床成功率为92.00%（23/25），其余2例需要再次栓塞。产后出血控制成功率为96.00%（24/25），其余1例于二次PAE术后死于低血容量休克。长期随访的23例患者术后均恢复了月经，其中4再次成功受孕。统计分析显示PPH后PAE术临床成功率与患者的分娩方式、并发弥散性血管内凝血(DIC)、大量输血（超过10个单位的压积红细胞）有关。

结论

PAE治疗PPH的最终临床成功率达96.00%，是安全有效的，对于合并DIC或需要大量输血的患者术后应密切观察。

关键词: 栓塞，治疗性, 产后大出血

Objective

To evaluate the safety and efficacy of pelvic arterial embolization (PAE) for treatment of primary postpartum hemorrhage (PPH), and to determine the factors associated with clinical outcomes.

Methods

A total of 25 patients who underwent PAE for primary PPH were retrospectively analyzed. Mode of delivery, causes of primary PPH, detailed laboratory and treatment records, and clinical outcomes were recorded. Univariate and multivariate analyses were performed to determine the factors related to clinical outcomes.

Results

Clinical success was achieved in 23 patients (23/25, 92.00%), the other 2 patients underwent repeat PAE. Overall bleeding control was achieved in 96.00% (24/25) patients, the other was died of hypovolemic shock after second session of PAE. Of the 23 patients with long-term follow-up, 23 (100%) restarted regular menstruation, and 4 became pregnant. Univariate analysis showed that caesarean section delivery, associated disseminated intravascular coagulation (DIC), and massive transfusion more than 10 red blood cell units were related to a high rate of clinical failure. Multivariate analysis showed that associated DIC and massive transfusion were significantly related to clinical failure.

Conclusions

PAE for primary PPH is safe and effective, with bleeding control successfully after PAE observed in 96.00% of patients. Patients with associated DIC and massive transfusion were likely to need careful observation after PAE.

Key words: Embolization, therapeutic, Primary postpartum hemorrhage

图1 右卵巢动脉栓塞图　A.栓塞前；B.栓塞后

图2 右子宫动脉栓塞图　A.栓塞前；B.栓塞后

图3 左卵巢动脉栓塞图　A.栓塞前；B.栓塞后

图4 左子宫动脉栓塞图　A.栓塞前；B.栓塞后

1	Al-Zirqi I, Vangen S, Forsen L, et al. Prevalence and risk factors of severe obstetric haemorrhage[J]. BJOG, 2008,115(10):1265-1272.
2	杨巨红．46例产后出血的临床分析[J]．浙江临床医学，2009,11(4):421-422．
3	Gonsalves M, Belli A. The role of interventional radiology in obstetric hemorrhage[J]. Cardiovasc Intervent Radiol, 2010,33(5):887-895.
4	Kirby JM, Kachura JR, Rajan DK, et al. Arterial embolization of primary postpartum hemorrhage[J]. J Vasc Interv Radiolm 2009,20(8):1036-1045.
5	Chauleur C, Fanget C, Tourne G, et al. Serious primary post-partum hemorrhage, arterial embolization and future fertility: a retrospective study of 46 cases[J]. Hum Reprod, 2008,23(7):1553-1559.
6	Lewis G. The confidential enquiry into maternal and child health (CEMACH). Saving mother’s lives: reviewing maternal deaths to make motherhood safer – 2003-2005[M]. London: CEMACH, 2007.
7	Royal College of Obstetricians and Gynaecologists (2007). The role of emergency and elective interventional radiology in postpartum hemorrhage. Royal College of Obstetricians and Gynaecologists Good Practice Guideline No. 6. Royal College of Obstetricians and Gynaecologists, London. Available at: URL
8	朱彬，朱锦桃，曹然.髂内动脉栓塞治疗产后大出血[J].介入放射学杂志，2006，15(4):218-220.
9	刘增佑，明建中，俞艇蔚,等.双侧髂内动脉栓塞术治疗难治性产后大出血临床分析[J].河北医药，2012，34(2):236-237.
10	White OD, Jeffrey RP, Michael T, et al. Pelvic embolization for intractable postpartum hemorrhage: long-term follow up and implications for fertility[J]. Obstet Gynecol, 2003,102(5 Pt 1):904-905.
11	Brown BJ, Heaston DK, Poulson AM, et al. Uncontrollable postpartum bleeding: A new approach to hemostasis through angiographic arterial embolization[J]. Obstet Gynecol, 1979,54(3):361-365.
12	Sentilhes L, Gromez A, Clavier E, et al. Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage[J]. Obstet Gynecol, 2009,113(5):992-999.
13	Descargues G, Mauger Tinlot F, Douvrin F, et al. Menses, fertility, and pregnancy after arterial embolization for the control of postpartum haemorrhage[J]. Hum Reprod, 2004,19(2):339-343.
14	Wang H, Garmel S. Successful term pregnancy after bilateral uterine artery embolization for postpartum hemorrhage[J]. Obstet Gynecol, 2003,102(3):603-604.
15	Tourné G, Collet F, Seffert P, et al. Place of embolization of the uterine arteries in the management of post-partum haemorrhage: a study of 12 cases[J]. Eur J Obstet Gynecol Reprod Biol, 2003,110(1):29-34.
16	Eriksson LG, Mulic-Lutvica A, Jangland L, et al. Massive postpartum hemorrhage treated with transcatheter arterial embolization: technical aspects and long-term effects on fertility and menstrual cycle[J]. Acta Radiol, 2007,48(6):635-642.
17	Gaia G, Chabrot P, Cassagnes L, et al. Menses recovery and fertility after artery embolization for PPH: a single-center retrospective observational study[J]. Eur Radiol, 2009,19(2):481-487.
18	柯要军，谭伟，张杰,等.致死性产后大出血的急诊动脉栓塞治疗[J].临床急诊杂志，2010,11(5):262-264.
19	Fargeaudou Y, Morel O, Soyer P, et al. Persistent postpartum haemorrhage after failed arterial ligation: value of pelvic embolisation[J]. Eur Radiol, 2010, 20(7):1777-1785.
20	Hardeman S, Decroisette E, Marin B, et al. Fertility after embolization of the uterine arteries to treat obstetrical hemorrhage: a review of 53 cases Fertil Steril[J]. Fertil Steril, 2010,94(7):2574-2579.

[1]	周载平, 胡泽民, 常晓健, 何坤, 孙强, 陈天宇. 栓塞化疗及射频的序贯应用对大肝癌术后复发防治的价值[J]. 中华普通外科学文献(电子版), 2018, 12(04): 246-250.
[2]	吴岑江, 唐楹, 曾凡剑, 黎坚. 原发性肝癌切除术后行肝动脉化疗栓塞治疗的疗效观察[J]. 中华普通外科学文献(电子版), 2018, 12(02): 111-114,123.
[3]	崔佳琪, 吴迪, 陈海艳, 周惠敏, 顾元龙, 周光文, 杨军. TACE术后并发肝脓肿的临床诊治分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 688-693.
[4]	孟泓宇, 卢逸, 曹彦龙, 戴操, 杨佳伟, 林楠, 徐见亮. 基于PSM比较TACE联合射频消融与单纯射频消融治疗小肝癌疗效[J]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 417-421.
[5]	卢文峰, 付雍, 阎凯, 袁建勇, 陈佩钦, 张海斌. 术后预防性TACE对肝内胆管细胞癌患者预后的影响[J]. 中华肝脏外科手术学电子杂志, 2022, 11(03): 268-272.
[6]	张凡, 汪学艳, 白琪, 王博方, 李玉民, 陈昊. 肝门部胆管癌术前评估和处理[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 446-448.
[7]	曹耿飞, 张海潇, 顾俊鹏, 朱帝文, 鲍应军, 阿斯哈尔·哈斯木, 任伟新. 载药微球栓塞联合索拉非尼治疗不可切除肝癌安全性和疗效[J]. 中华肝脏外科手术学电子杂志, 2021, 10(01): 43-47.
[8]	李一帆, 顾俊鹏, 纪卫政, 张海潇, 朱帝文, 任伟新. TACE联合RFA治疗BCLC中晚期肝癌患者预后的影响因素分析[J]. 中华肝脏外科手术学电子杂志, 2020, 09(06): 557-561.
[9]	张发林, 雍昉. 应用空白微球行TACE治疗肝癌临床疗效分析[J]. 中华肝脏外科手术学电子杂志, 2020, 09(04): 339-342.
[10]	李清汉, 甄作均, 陈应军, 司徒翠瑶. 肝细胞癌破裂出血的治疗[J]. 中华肝脏外科手术学电子杂志, 2020, 09(03): 260-263.
[11]	刘允怡, 赖俊雄. 肝癌微创介入治疗[J]. 中华肝脏外科手术学电子杂志, 2020, 09(03): 201-205.
[12]	陈姚, 陈义发, 刀辰冉, 阿力木江, 陈孝平. 肝细胞癌根治性切除术后复发患者不同局部治疗方法疗效比较[J]. 中华肝脏外科手术学电子杂志, 2018, 07(04): 305-310.
[13]	马继韬, 唐明星, 蒙旭, 王胤佳. 产后大出血早期并发肺栓塞一例[J]. 中华重症医学电子杂志, 2021, 07(04): 372-375.
[14]	敬聪, 任勇军, 邓进, 闵旭立, 徐浩, 陈智粮. 结直肠癌肝转移局部治疗的研究进展[J]. 中华临床医师杂志(电子版), 2019, 13(07): 540-543.
[15]	中国医师协会介入医师分会. 中国肝细胞癌经动脉化疗栓塞治疗临床实践指南[J]. 中华介入放射学电子杂志, 2019, 07(03): 178-184.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Clinical analysis of pelvic arterial embolization for treatment of primary postpartum hemorrhage

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Clinical analysis of pelvic arterial embolization for treatment of primary postpartum hemorrhage