子宫动脉化疗栓塞缓解中晚期妊娠合并前置胎盘引产术出血的临床应用

摘要

目的 探讨子宫动脉化疗栓塞预防和治疗中晚期前置胎盘引产术中大出血.方法 2008年2月至2012年2月收治32例妊娠中晚期合并前置胎盘需终止妊娠者,按引产方式分为对照组14例(利凡诺羊膜腔注射引产)和介入组18例(选择性双侧子宫动脉化疗栓塞术联合依沙吖啶(利凡诺)羊膜腔注射引产),术后24 h应用低分子右旋糖酐、复方丹参促进子宫侧支循环建立.比较两组产后出血率和输血率.结果 对照组产后大出血7例,输血7例,其中有3例采用选择性双侧子宫动脉栓塞术,1例行子宫切除术,平均出血量为(930±163)ml;介入组均未发生大出血,平均出血量为(228±20)ml,无输血及子宫切除病例,两组间差异有统计学意义(P＜0.05).结论 选择性子宫动脉化疗栓塞术可以有效预防和治疗中晚期妊娠因合并前置胎盘引产而引起的产道大出血.%Objective To evaluate the uterine arterial chemoembolization in protecting against and treating the massive bleeding occurred after the induction of labor for advanced stage of pregnancy complicated by placenta previa. Methods During the period from Feb. 2008 to Feb. 2012 a total of 32 patients with advanced stage of pregnancy complicated by placenta previa were admitted to authors' hospital. According to the type of induced labor, the patients were divided into control group (n = 14) and intervention group (n = 18). The induction of labor by using the intra-amniotic injection of ethacridine lactate was performed in the patients of the control group, while the induction of labor by using selective bilateral uterine arterial ehemoembolization combined with intra-amniotic injection of ethacridine lactate was carried out in the patients of the intervention group. Low molecular dextran and compound radix salviae miltiorrhizae were employed 24 hours after the treatment in order to promote the formation of uterine collateral circulation. The postpartum hemorrhage rate and blood transfusion rate were recorded, and the results were compared between the two groups. Results In the control group, the postpartum massive bleeding occurred in 7 patients. Blood transfusion was employed in 7 patients, of whom selective bilateral uterine artery embolization was employed in 3. Hysterectomy had to be carried out in one patient. The mean blood loss was (930 ±163) ml. In intervention group no postpartum massive bleeding occurred and the mean blood loss was only (228 ± 20) ml. Neither blood transfusion nor hysterectomy was needed. The differences between the two sTnuns were statistically significant (P< 0.05). Conclusion Selective uterine arterial ehemoemholization isrnan effective method to protect against and treat the massive bleeding occurred after the induction of labor for advanced stage of pregnancy complicated by placenta previa.