探讨超选择经导管动脉栓塞术(transcatheter arterial embolization, TAE)在重度产后出血(postpartum hemorrhage, PPH)中的临床价值。

对2002年8月至2008年12月，28例在本院分娩，曾采取保守治疗方法止血，止血效果不佳的重度产后出血患者[25例(89.3%)为宫缩乏力，3例(11.0%)为前置胎盘，无凝血功能障碍]，采用Seldinger技术超选择经导管动脉栓塞术进行止血治疗。所有患者经股动脉穿刺成功后，行经导管动脉插管栓塞术，以吸收性明胶海绵颗粒为栓塞材料。对行超选择经导管动脉栓塞术不能达到止血效果者，行卵巢动脉超选择栓塞。

25例(89.3%)重度产后出血患者经超选择经导管动脉栓塞术后，出血停止；另3例(10.7%)并行卵巢动脉栓塞后，出血停止。本组经股动脉插管成功率为100%，手术耗时为(35～65)min(平均为50 min)，术后止血总有效率为100%。对本组患者术后随访12个月(随访率为100%)，均恢复规律的月经来潮，无严重并发症发生。

超选择经导管动脉栓塞术治疗重度产后出血疗效确切，是一种快速、安全的微创治疗方法。

To investigate the clinic value of super selective transcatheter arterial embolization (TAE) treatment on severe postpartum hemorrhage(PPH).

Between August 2002 and December 2008, 28 patients did not work on the drugs treatment of severe postpartum hemorrhage, including 25 cases(89.3%)of uterine inertia and 3 cases(10.7%) of placenta previa which were performed super selective transcatheter arterial (uterine artery or iliac artery) embolization with absorbable gelatin sponge (gelfoam particles) by Seldinger technique in the Department of Gynecology and Obstetrics, Beijing General Army Hospital.

Bleeding was cessation after super selective arterial embolization in all patients(another 3 cases accept arterial embolization of ovary). Duration of surgery lasted 35~65 minutes, and the average time was 50 minutes. Both of the catheterization and bleeding halt successful rates were 100%. The follow-up study showed that 28 patients had normal menstrual periods in the next 12 months and no serious complications were found.

Super selective transcatheter arterial embolization is an effective method for severe postpartum hemorrhage with the characteristics of fast hemostasis and safe mini-invasive therapy.