刘帅+刘颖+刘明盛

[摘要] 目的 探讨子宫动脉栓塞术和子宫切除术治疗产后出血的临床效果。 方法 选择2009年1月～2014年12月本院收治的66例产后出血患者，根据治疗方法将其分为观察组（n=36）和对照组（n=30），观察组采用子宫动脉栓塞术治疗，对照组采用子宫切除术治疗，观察两组的临床疗效。 结果 观察组的手术时间、术中出血量、住院时间、住院费用分别为（30.30±11.51） min、（1081.54±650.65） ml、（8.33±1.22） d、（10 349.17±4048.97）元，对照组组分别为（97.26±30.22） min、（2273.33±690.38） ml、（13.22±4.68） d、（19 445.00±4577.99）元，两组差异有统计学意义（P<0.05）。观察组的治疗总有效率为94.4%，2例手术失败，对照组为100%，全部成功，两组差异无统计学意义（P>0.05）。 结论 子宫动脉栓塞术用于难治性产后出血具有操作简单、手术时间短、止血迅速彻底、安全、微创、疗效肯定、可重复、副作用小、恢复快、不丧失生育能力等优点，值得临床推广应用。

[关键词] 子宫动脉栓塞术；子宫切除术；产后出血；剖宫产；子宫收缩乏力

[中图分类号] R714.46+1 [文献标识码] A [文章编号] 1674-4721（2015）07（b）-0063-03

[Abstract] Objective To explore the clinical effect of uterine arterial embolization and hysterectomy in the treatment of postpartum hemorrhage. Methods 66 patients with postpartum hemorrhage admitted into our hospitai from January 2009 to December 2014 were selected.According to the treatment divided into the observation group（n=36） and the control group（n=30）.Observation group was treated with uterine artery embolization.Control group was received hysterectomy.The clinical effects of two groups was observed. Results Surgical time，volume of bleeding during surgery，length of stay，hospitalization expense in observation group was （30.30±11.51） min，（1081.54±650.65） ml，（8.33±1.22） d and （10 349.17±4048.97） yuan，in control group was （97.26±30.22） min，（2273.33±690.38） ml，（13.22±4.68） d and （19 445.00±4577.99） yuan，the difference was significant（P<0.05）.The total effective rate in observation group was 94.4%，2 cases of surgical failure.The control group was 100%，all patients were operated successfully.The difference between the two groups was not statistically significant（P>0.05）. Conclusion Uterine arterial embolization in the treatment of refractory postpartum hemorrhage has advantages such as simple procedure，short surgical time，rapid and radical hemostasis，good safety，minimal invasion，exact curative effect，repeatability，less adverse effects，retaining fertility and so on，which is worthy of clinical promotion and application.

[Key words] Uterine arterial embolization；Hysterectomy；Postpartum hemorrhage；Cesarean section；Uterine atony

产后出血是产妇分娩过程中的常见并发症，轻者影响分娩，重者直接对产妇及围生儿构成生命威胁。当对产妇采取积极充分的保守治疗措施无效后，适时实施子宫切除术是抢救产妇生命的一项重要措施。子宫切除术是一种临床常用的抢救产科大出血的治疗方式[1]，其往往会对产妇的身体健康造成重要的影响，比如无法生育等可对产妇的心理和身体产生严重伤害，同时在子宫切除术的过程中会因为各种原因而发生并发症，对手术的成功率有一定影响[2]。为进一步分析产科子宫切除术治疗产后出血的效果，本研究对子宫切除术和子宫动脉栓塞术治疗产后出血的临床效果进行比较。……