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目的评价盆腔动脉栓塞术(PAE)治疗急性难治性植入性胎盘(PA)伴有相关的产后出血(PPH)的价值。方法对植入性胎盘产后出血行动脉栓塞的40例病人进行回顾性研究。回顾了分娩和盆腔动脉栓塞的治疗过程。通过电话方式随访髂动脉栓塞术后的效果。结果所有病人栓塞术均成功(100%)。最初的临床治愈率为82.5%(33/40)。3例病人在栓塞术后未能成功止血,于栓塞术后24h内进行了子宫切除,3例病人进行了再次栓塞术(2例在栓塞术后2d行再次栓塞,1例在首次栓塞术后6h行再栓塞),病人出血最终得以控制。临床成功率为92.5%。有4例病人术后立即出现了并发症,例如骨盆疼痛、恶心、荨麻疹。有3例出现较轻的远期并发症,即短时期的停经。病人均未出现较严重的远期并发症。有35例栓塞术后恢复了正常月经,包括2例单纯妊娠。1例病人尽管栓塞术成功止血,但因出现弥漫性血管内出血及脑内出血而死亡。结论 PAE可以安全有效地治疗很多PA伴有相关的PPH,许多病人可以避免切除子宫。PAE很少有严重并发症。要点①PAE是治疗产后出血的一种重要治疗方法。②PAE治疗PA伴PPH可能是安全和有效的。③PAE治疗保留子宫功能,不影响月经。④PAE很少有严重的并发症。
Objective To evaluate the value of pelvic arterial embolization (PAE) in the treatment of acute refractory placenta accreta (PA) associated with postpartum hemorrhage (PPH). Methods A retrospective study was performed on 40 patients who underwent arterial embolization with placental placental hemorrhage. Review of labor and pelvic artery embolization treatment process. Follow-up by phone after iliac artery embolization. Results All patients had successful embolization (100%). The initial clinical cure rate was 82.5% (33/40). Three patients failed to stop bleeding after embolization. Hysterectomy was performed within 24 h after embolization. Three patients underwent re-embolization (two patients embolized again 2 days after embolization and one patient after initial embolization 6h line re-embolization), the patient bleeding eventually be controlled. The clinical success rate was 92.5%. Four patients developed complications immediately after their surgery, such as pelvic pain, nausea and urticaria. There are three cases of lighter long-term complications, that is, short-term menopause. Patients did not appear more serious long-term complications. 35 cases of normal menstruation after embolization, including 2 cases of simple pregnancy. One patient died of hemostasis despite successful embolization, but died of diffuse intravascular hemorrhage and intracerebral hemorrhage. Conclusions PAE can safely and effectively treat many PA with related PPH, and many patients can avoid uterine resection. PAEs rarely have serious complications. Point ① PAE is an important treatment for postpartum hemorrhage. ② PAE treatment of PA with PPH may be safe and effective. ③ PAE treatment to retain uterine function, does not affect menstruation. ④ PAE rarely serious complications.