- 期刊
計畫性運用術中子宮動脈栓塞術控制產後出血
Assessment of Strategic Intraoperative Uterine Artery Embolization to Prevent Postpartum Hemorrhage and Retain the Uterus
摘要
植入性胎盤是造成產婦在生產過程中引發大出血的原因之一，當發生產後大出血處理原則為施打子宮收縮劑或子宮切除術，施打子宮收縮劑的止血技術，因需多次輸血恐引起瀰漫性血管內凝血病變，子宮切除術雖可止住大出血同時也喪失生育能力。本研究目的針對患有植入性胎盤產婦使之保有子宮與降低出血量。我們提出術中子宮動脈栓塞術於植入性胎盤病人，最終目標為保有子宮與降低出血量。植入胎盤影像確診為磁振造影胎盤影像，了解胎盤分級與血管的扭轉部份，提供婦產科剖腹下刀的重要資訊。材料與方法上利用開刀房一般型移動式透視型X光機搭配錄影機將原本只能即時的影像轉為可回溯觀看。本研究從2003年起迄今共收入19例產婦，其中16例參與術中子宮動脈栓塞術為實驗組，另外3例為出血後子宮動脈栓塞病患本研究對照組。統計方面對於成功保有子宮與降低產後出血達到良好效果，統計方面比較是否保有子宮利用卡方檢定P＜0.053違統計學上明顯意義。比較總出血量方面，術中子宮動脈栓塞術為1109毫升，出血後子宮動脈栓塞為11160毫升，利用獨立樣本t檢定P＜0.05本研究使用術中子宮動脈栓塞術可以有效降低產後出血量與成功保有子宮。
並列摘要
Placenta accrete is one of the major causes of postpartum hemorrhage. In recent years, there has been increased incidence of placenta accrete due to popularity of caesarian sections. At the present, management of placenta accrete include timely hysterectomy after delivery or supportive care. However, even prompt hysterectomy may cause catastrophic bleeding and it's not the option for patients who wish for future pregnancy. The main objective of this study is to maintain the maternal uterus and health Discharge. On the other hand, conservational hemostasis probably not enough for hypotensive shock caused by massive bleeding and multiple transfusions may induce unwarranted disseminated intravascular coagulopathy or even obstetric death. Preventive endovascular embolization of uterine arteries executed by the experienced radiologists, and with proper schedule arrangement and equipment preparation as opposed to emergent situation yields significant better results. Although there had been only 19 accumulated cases since first such trial in 2003, but the result of 100 percent successful rate still makes it worthwhile for promotion. Three cases of failure taking hysterectomy. Total of nineteen cases patients. Our experience is new approaches for management of placenta accrete. The total quantity of bleeding placenta accreta use plan for the 1109 ml of blood clots in the Caesarean section without warning outside the hospital bleeding cause bleeding embolism failed to 11 ,160 ml, using independent sample t test P ＜0.05, and Compare whether to maintain the utilization of the chi-square test of uterine P ＜0.053. using uterine artery embolization can be planned effectively reduce postpartum bleeding reached a statistically significant sense .With the readily available state of art equipments and advanced techniques in most hospitals, this new strategy can be applied to reduce to risk of postpartum bleeding from placenta accrete, prevent maternity death and preserving uterus at the same time.