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目的探讨采用子宫动脉栓塞(uterine artery embolization,UAE)介入治疗产后出血(postpartum hemorrhage,PPH)的疗效及其安全性。方法回顾性分析2009年11月至2014年9月广元市第一人民医院妇产科收治的60例难治性PPH患者的临床资料,根据不同治疗方式分为观察组(35例)和对照组(25例)。观察组采用UAE介入治疗;对照组采用子宫收缩药物、子宫按摩、宫腔填塞纱布、子宫B-Lynch缝合、Cho缝合、Hwa缝合、子宫动脉结扎等传统方法治疗,比较两组患者临床治疗的手术时间、术后住院时间、术后首次下床活动时间、子宫切除率和死亡率。结果对照组患者的子宫切除率和死亡率(20.0%、8.0%)明显高于观察组(2.9%、0%)(P<0.05);观察组平均手术时间、术后平均住院时间[(40.27±2.48)min、(7.42±1.24)d]均显著短于对照组[(80.46±4.77)min、(10.34±2.18)d](P<0.05);观察组术后首次下床活动时间[(5.04±1.34)h]长于对照组[(3.17±1.13)h](P<0.05)。结论 UAE介入治疗能显著减少PPH,提高了难治性PPH的抢救成功率。
Objective To investigate the efficacy and safety of uterine artery embolization (UAE) interventional treatment for postpartum hemorrhage (PPH). Methods The clinical data of 60 patients with refractory PPH admitted to Department of Obstetrics and Gynecology of First People ’s Hospital of Guangyuan from November 2009 to September 2014 were retrospectively analyzed. According to the different treatment methods, they were divided into observation group (35 cases) and control group (25 cases). The patients in the observation group were treated by UAE intervention. The control group was treated by traditional methods such as uterine contraction medicine, uterine massage, intrauterine stuffing gauze, uterus B-Lynch suture, Cho suture, Hwa suture, uterine artery ligation and so on. Time, postoperative hospital stay, time to first bed activity, hysterectomy and mortality. Results The average rate of hysterectomy and mortality (20.0%, 8.0%) in the control group was significantly higher than that in the observation group (2.9%, 0%) (P <0.05). The mean operation time, average postoperative hospital stay [(40.27 ± 2.48) min, (7.42 ± 1.24) d] were significantly shorter than those in the control group [(80.46 ± 4.77) min, (10.34 ± 2.18) d], respectively 5.04 ± 1.34 h) was longer than that of the control group [(3.17 ± 1.13) h] (P <0.05). Conclusion UAE intervention can significantly reduce PPH and improve the rescue success rate of refractory PPH.