Departments of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan.
PLoS One. 2013 Oct 11;8(10):e77494. doi: 10.1371/journal.pone.0077494. eCollection 2013.
The liquid embolic agent n-butyl cyanoacrylate (NBCA) is a tissue adhesive used as an immediate and permanent embolic agent when mixed with oil-based contrast medium. In this study, the preservation of fertility with TAE using NBCA for massive haemorrhage during pregnancy or the peripartum period and the utility of this therapy were investigated.
Cases from January 2005 to October 2010 in which TAE was performed for massive haemorrhage in pregnant women, particularly during the peripartum period, were investigated.
TAE was performed in 27 pregnant women. The embolic agent used was GS only in five cases, NBCA only in 19 cases, and additional embolization with NBCA when the effect with GS was insufficient in three cases, one each of abruptio placentae, cervical pregnancy, and uterine atony.A comparison of mean blood loss when each embolic agent was used for haemostasis showed a significant difference between cases in which GS only was used and cases in which NBCA only was used. In a comparison of mean transfusion volume, a significant difference was seen between cases in which both GS and NBCA were used and cases in which NBCA only was used. In a postoperative follow-up survey, menses resumed in eight patients, including four patients who later became pregnant and three who delivered.
TAE with NBCA, which has an embolic effect unrelated to clotting dysfunction for massive haemorrhage during the peripartum period, is a minimally invasive and very effective treatment method for patients with severe DIC.
正丁基氰基丙烯酸酯（NBCA）是一种液体栓塞剂，与油基对比剂混合后可作为即刻且永久性的栓塞剂使用。本研究旨在探讨使用 NBCA 行 TAE 治疗妊娠或围产期大出血以保留生育功能的效果和这种治疗方法的实用性。
回顾性分析 2005 年 1 月至 2010 年 10 月期间因妊娠期间（尤其是围产期）大出血而行 TAE 的病例。
共 27 例孕妇接受了 TAE 治疗。栓塞剂的使用情况为：5 例仅使用明胶海绵（GS），19 例仅使用 NBCA，3 例因 GS 效果不理想而额外使用 NBCA，分别为胎盘早剥、宫颈妊娠和子宫收缩乏力各 1 例。对每种栓塞剂用于止血时的平均出血量进行比较，发现仅使用 GS 的病例与仅使用 NBCA 的病例之间存在显著差异。对平均输血量进行比较，发现同时使用 GS 和 NBCA 的病例与仅使用 NBCA 的病例之间存在显著差异。术后随访调查显示，8 例患者恢复月经，其中 4 例后来怀孕，3 例分娩。
对于围产期大出血伴有严重 DIC 的患者，使用 NBCA 的 TAE 是一种微创且非常有效的治疗方法，其栓塞效果与凝血功能障碍无关。
