27例妇产科出血性疾病的介入治疗效果分析
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| 时间：2009-02-11 22:22:16 来源： 作者： |
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Analysis of interventional treatment effects of gynecologic hemorrhage diseases
JIN Wunan1， JIN Yanze2
(1.Department of Oncology;2.Department of Gynaecology and Obstetrics: Affiliated Hospital of Yanbian University,Yanji 133000, Jilin, China)
ABSTRACT:BACKGROUNDTo study the significance of interventional treatment effects for the gynecologic hemorrhage diseases.CASE REPORTSUterine arterial embolization were performed with Seldinger interventional radiology in 27 cases of gynecologic hemorrhage caused by different kinds of reasons. Hemorrhage from vagina in 26 of 27 cases reduced significantly after operation, 1 case failed after 12 hours whereat accepted second reembolization, blood liking discharge from vagina disappeared about 10 days．The patients represented only slight abdomina1 pain and fever of different level, and no case was showed severe complication.DISCUSSIONUterine arteria1 embolization is a safe and reliable method to control gynecologic hemorrhage with the characteristics of fast hemostasis and 1ess complications.
Key words:embolization, therapeutic;uterine hemorrhage;treatment outcome
目前，随着放射介入技术的迅速发展，血管介入技术在妇产科疾病治疗中得以广泛应用.自1973年首例应用介入技术治疗盆腔外伤出血被报道以来，动脉导管栓塞术已逐渐替代外科手术治疗妇产科出血性疾病.延边大学附属医院自2003年1月至2007年12月间应用经股动脉选择性动脉栓塞术给27例妇产科出血性疾病患者进行治疗，取得了满意的疗效.
1 资料和方法
1.1 一般资料 2003年1月至2007年12月间，延边大学附属医院共收治经各种保守治疗无效的妇产科出血性疾病患者27例，年龄为25～55岁，平均为42岁.27例患者中宫颈癌出血者为8例，剖宫产术后子宫出血为10例（6例发生失血性休克），子宫肌瘤继发出血致中、重度贫血者为6例，胎盘植入为3例.
1.2 方法 给急性出血患者行抗休克治疗的同时，采用Seldinger’s技术在局部麻醉下行右侧股动脉穿刺插管置入血管鞘，选用5F Cobra导管将其插入至左侧髂内动脉，同步摄取盆腔血管数字减影血管造影影像，明确出血部位及血管分布，在同轴导丝引导下超选择性进入左侧髂内动脉前干或子宫动脉，灌注抗癌药物(恶性肿瘤患者)后，用明胶海绵颗粒行栓塞，造影证实后，采用成襻技术给对侧血管进行插管及栓塞，穿刺部位加压包扎，平卧24h，术后给予抗感染、补液及镇痛等治疗.
2 结果
2.1 造影表现和栓塞情况
2.1.1 宫颈癌出血 出血多为肿瘤侵犯血管破溃所致，出血动脉源自髂内动脉前干分支，包括子宫动脉、阴部内动脉及膀胱上动脉等，造影显示子宫动脉增粗,分支紊乱,扭曲形成病理性血管团，实质期呈现肿瘤染色，可清楚地显示肿瘤大小及范围.2例患者肿瘤侵犯周围组织，相应部位出现造影剂染色并表现出毛刺现象.栓塞后可见子宫动脉或髂内动脉前干远端闭锁.
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