Interventional Radiology Department, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine - Assistance Publique-Hôpitaux de Paris - Hôpital Européen Georges-Pompidou, Paris, France.
Cardiovasc Intervent Radiol. 2013 Feb;36(1):98-104. doi: 10.1007/s00270-012-0355-7. Epub 2012 Feb 11.
To evaluate the efficacy and safety of superselective embolization of the uterine arteries in a postpartum hemorrhage.
Between November 2004 and January 2011, a total of 44 consecutive women (median ± standard deviation age 34 ± 3 years, range 23-41 years) were referred to our institution for postpartum intractable hemorrhage management. All patients were embolized with a microcatheter that was placed deep into the uterine arteries upstream of the cervical arteries. The embolic agent was a mixture of contrast medium and 5 × 5 × 5 cm pieces of gelfoam (Gelita-Spon) modified into a gelatin emulsion as follows: rapid mixing through a three-way stopcock with two 2.5-ml syringes. A 1-ml syringe was used for injection. One month after embolization, all patients underwent magnetic resonance imaging and clinical examination.
Technical and clinical success was obtained in all cases. Thirty-five patients experienced bleeding related to poor retraction of the uterus, 7 patients because of a tear of the cervix and 2 because of a vaginal hematoma. Pre- and postembolization red blood cell transfusions were (mean ± standard deviation [SD]) 6 ± 1.2 (range 3-8) U and 2 ± 0.7 (range 2-4) U, respectively. One-month magnetic resonance imaging follow-up revealed no sign of ischemic myometrium or necrosis, and no instances of uterine rupture and no pelvic vein thrombosis. Incidental findings included two small intramyometrial hematic collections. All uterine arteries were patent via magnetic resonance angiography. Seventeen patients had concomitant fibroids, all of which appeared hypovascular.
This technique permits good, safe clinical results with no marked damage to the uterine arteries or the uterus itself.
评估超选择性子宫动脉栓塞术治疗产后出血的疗效和安全性。
2004 年 11 月至 2011 年 1 月，共有 44 例连续的产后出血患者（中位数±标准差年龄 34±3 岁，范围 23-41 岁）被转介至我院进行产后难治性出血管理。所有患者均使用微导管进行栓塞，微导管被放置在颈内动脉上游的子宫动脉深部。栓塞剂为造影剂和 5×5×5cm 大小的明胶海绵（Gelita-Spon）的混合物，制成明胶乳剂，具体方法如下：通过三通旋塞用两个 2.5ml 注射器快速混合。使用 1ml 注射器进行注射。栓塞后 1 个月，所有患者均进行磁共振成像和临床检查。
所有病例均获得技术和临床成功。35 例患者因子宫收缩不良而出血，7 例患者因宫颈撕裂，2 例患者因阴道血肿而出血。栓塞前后红细胞输注量（均值±标准差[SD]）分别为 6±1.2（范围 3-8）U 和 2±0.7（范围 2-4）U。1 个月后的磁共振成像随访显示无缺血性子宫肌或坏死迹象，无子宫破裂和盆腔静脉血栓形成。偶然发现包括 2 个小的子宫肌内血肿。所有子宫动脉均通过磁共振血管造影显示通畅。17 例患者同时伴有子宫肌瘤，均表现为低血供。
该技术可获得良好、安全的临床效果，对子宫动脉和子宫本身无明显损伤。
