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目的对比分析经导管动脉栓塞术与子宫切除术治疗难治性产后出血的疗效及安全性。方法选取2012年1月—2015年12月收治的难治性产后出血患者60例,根据随机数字表法分为观察组与对照组各30例。观察组接受经导管动脉栓塞术治疗,对照组接受子宫切除术治疗。统计两组手术时间、首次下床活动时间、术后住院时间;对比止血效果及子宫切除率、术后并发症发生率。计量资料比较采用t检验,计数资料比较采用χ~2检验,P<0.05为差异有统计学意义。结果观察组手术时间、首次下床活动时间、术后住院时间低于对照组,比较差异有统计学意义(均P<0.05)。两组止血成功率比较差异无统计学意义(P>0.05)。观察组子宫切除率(10.00%)低于对照组(100.00%)(P<0.05)。观察组继发性贫血、发热、臀部及会阴部疼痛发生率(0、46.67%、63.33%)低于对照组(53.33%、76.67%、100.00%),比较差异有统计学意义(均P<0.05)。结论经导管动脉栓塞术与子宫切除术治疗难治性产后出血的止血效果相当,但经导管动脉栓塞术创伤小、恢复快、并发症发生率低,且可保留子宫。
Objective To compare and analyze the curative effect and safety of transcatheter arterial embolization and hysterectomy in refractory postpartum hemorrhage. Methods Sixty patients with refractory postpartum hemorrhage admitted from January 2012 to December 2015 were selected and divided into observation group and control group according to the random number table. The observation group received transcatheter arterial embolization and the control group received hysterectomy. The operation time, initial ambulation time and postoperative hospital stay were compared between the two groups. The hemostatic effect, hysterectomy rate and postoperative complication rate were compared. Measurement data were compared using t test, count data were compared using χ ~ 2 test, P <0.05 for the difference was statistically significant. Results The operation time of the observation group, the time of initial ambulation and the postoperative hospital stay were lower than those of the control group (all P <0.05). There was no significant difference between the two groups in the success rate of hemostasis (P> 0.05). The hysterectomy rate (10.00%) in the observation group was lower than that in the control group (100.00%) (P <0.05). The incidence of secondary anemia, fever, buttocks and perineal pain in the observation group was lower than that in the control group (53.63%, 76.67%, 100.00%) (0, 46.67%, 63.33%, P < 0.05). Conclusions Transcatheter arterial embolization and hysterectomy for the treatment of refractory postpartum hemorrhage have similar hemostatic effects. However, transcatheter arterial embolization has less trauma, faster recovery and lower complication rate, and can retain the uterus.