目的探讨子宫动脉(或髂内动脉)栓塞术在防治子宫出血性疾病中的应用价值。方法收集南阳医学高等专科学校第一附属医院2012年5月—2014年5月31例在介入科行子宫动脉(或髂内动脉)栓塞术住院患者,所有患者均在DSA(数字显影血管造影)下采用Seldinger技术行子宫动脉(或髂内动脉)栓塞治疗。结果例1剖宫产术中产后大出血行子宫次全切术,术后8h发现腹腔内出血达1500ml,子宫颈残端血肿,给予髂内动脉栓塞术效果良好,避免了一次非计划再次手术。例2早产后胎盘滞留,B超发现整个胎盘完全性植入子宫肌层,几乎穿透子宫浆膜层,先行子宫动脉栓塞术,于术后第2d行剖宫手取胎盘术,术中出血不多,未输血,手术顺利。术后胎盘组织细菌培养为屎肠球菌G+球菌,对万古霉素敏感,术后10d出院。例3是胎儿与葡萄胎共存患者,停经4+月胎儿大小符合16孕周,先给引产药物2d,于第3d行子宫动脉栓塞术,于第4天给与米索前列醇片2片口服,胎儿排出后行葡萄胎清宫术,术中出血不多,子宫收缩良好。例4~13,均为孕3+月胎盘附着于子宫疤痕部,于子宫动脉栓塞术后第2d,在手术室B超引导下行钳刮术,术中出血不多,手术顺利。例14~27,孕天50+天~2+月,为子宫疤痕部妊娠,于子宫动脉栓塞术后第2天,在手术室B超引导下行人工流产术,术中出血不多,手术顺利。其中1例子宫疤痕部妊娠并胎盘植入患者因误诊给予人工流产,人流术中大出血行子宫动脉栓塞术效果欠佳,栓塞术中发现因左侧子宫动脉畸形致栓塞效果不良,曾多次复查B超,均提示宫腔内不均质回声,大小约6×5cm,于栓塞术后第6d在B超引导下行清宫术,术中再次大出血,急诊剖腹探查发现为子宫疤痕部妊娠,子宫疤痕部切开清除妊娠组织,缝扎血管出血停止。例28~30例为功血,年龄分别为42、48、53岁,24 h阴道流血700~800ml,患者均合并有严重贫血,心功能不全,不能耐受手术,子宫动脉栓塞术后阴道出血明显减少。例31,胎盘早剥产后大出血并发DIC行子宫全切术后行髂内动脉栓塞术无效死亡。结论子宫动脉(或髂内动脉)栓塞术是防治子宫出血性疾病的有效方法。但应严格掌握适应症。 Objective To investigate the value of uterine artery (or internal iliac artery) embolization in the prevention and treatment of uterine hemorrhagic disease. Methods The first Affiliated Hospital of Nanyang Medical College was collected from May 2012 to May 2014. Among 31 patients undergoing uterine arterial (or internal iliac artery) embolization, all patients underwent DSA (digital imaging angiography) Under the Seldinger technique uterine artery (or internal iliac artery) embolization treatment. Results Example 1 postpartum hemorrhage in cesarean section subtotal hysterectomy, 8h after intraperitoneal hemorrhage was found 1500ml, cervical stump hematoma, giving internal iliac artery embolization good effect, to avoid an unplanned reoperation. Case 2 premature delivery of the placenta, B-ultrasound found that the entire placenta completely implanted into the myometrium, almost penetrating the uterine serosa, uterine artery embolization, 2d postoperative cesarean section placenta accreta, intraoperative bleeding is not More, no blood transfusion, surgery smoothly. The placental tissue was cultured as Enterococcus faecium G +, which was sensitive to vancomycin and was discharged after 10 days. Example 3 is the fetus and hydatidiform mole coexistence of patients, menopause 4 + month fetus size in line with 16 weeks of gestation, giving induction of labor drugs 2d, uterine arterial embolization in the 3d line, on the 4th day to give misoprostol tablets 2 orally After the fetus discharged hydatidiform mole, intraoperative bleeding is small, uterine contraction is good. Cases 4 to 13, were pregnant 3 + month placenta attached to the uterine scar in the uterine artery embolization 2d, B-guided in the operating room descending forceps curettage, bleeding during surgery, the operation went well. Cases of 14 to 27, 50 days of pregnancy +2 months, for the uterus scar pregnancy, uterine arterial embolization in the first 2 days, the B-guided abortion in the operating room abortion, bleeding during surgery, smooth operation . One case of uterine scar pregnancy and placenta accreta caused by misdiagnosis of induced abortion, bleeding in abortion uterine artery embolization ineffective embolization found in the left uterine artery malformation caused by poor embolization, has repeatedly reviewed B ultrasound, were prompted intrauterine inhomogeneous echo, the size of about 6 × 5cm, 6d after embolization in B-guided radical curettage, bleeding again during surgery, emergency laparotomy found for uterine scar pregnancy, uterine scar Department of pregnancy to remove the incision, suture vascular bleeding stopped. Cases of 28 to 30 cases of dysfunctional uterine bleeding, respectively, age 42, 48, 53 years old, 24 h vaginal bleeding 700 ~ 800ml, patients were complicated with severe anemia, cardiac insufficiency, can not tolerate surgery, uterine bleeding after vaginal bleeding obviously decrease. Example 31, placental abruption postpartum hemorrhage complicated by DIC line hysterectomy iliac artery embolization ineffective death. Conclusion Uterine artery (or internal iliac artery) embolization is an effective method to prevent and treat uterine hemorrhagic disease. But should be strictly controlled indications.