Tang P P, Hu H Y, Gao J S, Hu J, Zhong Y F, Wang T, Song Y N, Zhou X Y, Yang J Q, Liu J T, Pan J, Shi H F
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Fu Chan Ke Za Zhi. 2016 Feb;51(2):81-6. doi: 10.3760/cma.j.issn.0529-567X.2016.02.001.
To evaluate the efficacy and safety of pelvic arterial embolization (PAE) in women with intractable primary postpartum hemorrhage (PPH).
Clinical data of 36 cases were analyzed retrospectively in which women underwent PAE for intractable primary PPH in Peking Union Medical College Hospital between Jan 2006 and Jan 2015. The success rate of PAE were measured and possible predictive risk factors associated with treatment failure were analyzed. The complications secondary to PAE were also recorded.
(1) The etiology of PPH. Among the 36 cases, 21 patients delivered viginally (Group VD) and 15 received cesarean section (Group CS). The most frequent cause of PPH was uterine atony (72%, 26/36). The less common causes were placental problems (28%, 10/36), genital tract trauma (6%, 2/36) and coagulation defects (3%, 1/36) in turn. Three patients (8%, 3/36) had combined causes. (2) Interventions before PAE. Uterotonic medications were used in all patients. 31 patients received carboprost methylate suppositorites, 27 received carbetocin and 31 received carboprost tromethamine. Besides, 20 patients received one or more surgical interventions before PAE. PAE was performed when these interventions failed. (3) Characteristics of PAE. Altogether 78 arteries were embolized in 36 cases. Embolization of bilateral uterine arteries was performed in 31 cases, right internal iliac artery and bilateral inferior epigastric arteries were embolized in one case. Right internal pudendal artery, bilateral uterine arteries and bilateral internal iliac arteries were embolized in one case. And bilateral uterine arteries, bilateral internal iliac arteries were embolized in one case. In the other 2 cases, bilateral internal iliac arteries were embolized. (4) Efficacy of PAE. The overall technical success rate of PAE was 100%(36/36), while the clinical success rate was 94%(34/36). All patients survived. (5) Complications of PAE. 15 patients were transferred to ICU after PAE for 1 to 7 days. Except self-limited fever, no puncture site hematoma, buttock necrosis or vessel rupture was observed. The effect on menstrual cycle and fertility were followed in 25 patients. 17 (68%, 17/25) reported resumption of normal menses and 8 (32%, 8/25) reported amenorrhea. Three pregnancies after PAE were observed.
PAE is a safe and effective treatment for intractable primary PPH which can prevent hysterectomy and preserve fertility of patients.
评估盆腔动脉栓塞术（PAE）治疗难治性原发性产后出血（PPH）女性患者的疗效及安全性。
回顾性分析2006年1月至2015年1月在北京协和医院因难治性原发性PPH接受PAE治疗的36例患者的临床资料。测定PAE的成功率，分析与治疗失败相关的可能预测风险因素。记录PAE继发的并发症。
（1）PPH的病因。36例患者中，21例经阴道分娩（VD组），15例接受剖宫产（CS组）。PPH最常见的原因是宫缩乏力（72%，26/36）。较不常见的原因依次为胎盘问题（28%，10/36）、生殖道创伤（6%，2/36）和凝血功能缺陷（3%，1/36）。3例患者（8%，3/36）有合并病因。（2）PAE前的干预措施。所有患者均使用宫缩剂。31例患者使用卡前列甲酯栓，27例使用卡贝缩宫素，31例使用卡前列素氨丁三醇。此外，20例患者在PAE前接受了一项或多项手术干预。当这些干预措施失败后进行PAE。（3）PAE的特点。36例患者共栓塞78条动脉。31例行双侧子宫动脉栓塞，1例行右侧髂内动脉及双侧腹壁下动脉栓塞，1例行右侧阴部内动脉、双侧子宫动脉及双侧髂内动脉栓塞，1例行双侧子宫动脉及双侧髂内动脉栓塞，另外2例行双侧髂内动脉栓塞。（4）PAE的疗效。PAE的总体技术成功率为100%（36/36），临床成功率为94%（34/36）。所有患者均存活。（5）PAE的并发症。15例患者PAE后转入ICU 1至7天。除自限性发热外，未观察到穿刺部位血肿、臀部坏死或血管破裂。对25例患者随访了月经周期和生育能力的影响。17例（68%，17/25）报告月经恢复正常，8例（32%，8/25）报告闭经。观察到3例PAE后妊娠。
PAE是治疗难治性原发性PPH的一种安全有效的方法，可避免子宫切除术并保留患者生育能力。
