(1)背景:四分之一的孕产妇死亡是由产后出血引起的;因此,产科出血是妇女发病和死亡的重要原因。盆腔动脉栓塞(PAE)是一种微创介入手术,在妇产科大量出血的保守治疗中起着重要作用。这项研究的目的是评估PAE在具有不同妇产科病理的明显阴道出血患者中的作用和并发症。(2)方法:我们进行了观察,回顾性研究了1135例患者,这些患者到布加勒斯特大学急诊医院接受血管内治疗的各种病因的阴道出血。研究中包括的所有患者均出现由以下原因引起的阴道出血:子宫平滑肌瘤,生殖道恶性肿瘤,异位妊娠,动静脉畸形和其他产科原因。我们排除了高血压失控的患者,严重肝功能损害,充血性心力衰竭,肾功能衰竭或室性心律失常。(3)结果:子宫肌瘤出血占88.19%(n=1001),7.84%(n=89)的宫颈癌,2.29%的异位妊娠(n=26),动静脉畸形占1.23%(n=14),产科原因大出血占0.52%。所有病例均采用血管内手术。在子宫平滑肌瘤患者中,使用超选择性子宫动脉栓塞术。在97%(n=1101)的患者中,第一次尝试PAE后止血.3%(n=34)需要第二次栓塞。14例AVM中有12例,PAE成功了,另外2例需要再次干预;(4)结论:血管内手术是妇产科急性和慢性出血的主要治疗方法.它可以用于产后或创伤后阴道出血的原因,而且在患有子宫平滑肌瘤或无法手术的生殖器恶性肿瘤的慢性出血患者中,甚至在大量子宫肌瘤或浸润性恶性肿瘤的情况下作为术前辅助治疗,旨在减少术中出血。
(1) Background: A quarter of maternal deaths are caused by post-partum hemorrhage; hence obstetric bleeding is a significant cause of morbidity and mortality among women. Pelvic artery embolization (PAE) represents a minimally invasive interventional procedure which plays an important role in conservative management of significant bleeding in Obstetrics and Gynecology. The aim of this study was to evaluate the effect and the complications of PAE in patients with significant vaginal bleeding with different obstetrical and gynecological pathologies. (2) Methods: We conducted an observational, retrospective study on 1135 patients who presented to the University Emergency Hospital of Bucharest with vaginal bleeding of various etiology treated with endovascular therapy. All the patients included in the study presented vaginal hemorrhage that was caused by: uterine leiomyomas, genital tract malignancies, ectopic pregnancy, arterio-venous mal-formations and other obstetrical causes. We excluded patients with uncontrolled high blood pressure, severe hepatic impairment, congestive heart failure, renal failure or ventricular arrhythmias. (3) Results: Bleeding was caused in 88.19% of cases by uterine leiomyomas (n = 1001), 7.84% (n = 89) by cervical cancer, 2.29% by ectopic pregnancy (n = 26), 1.23% by arteriovenous malformation (n = 14) and 0.52% by major hemorrhage of obstetrical causes. Endovascular procedures were used in all the cases. In patients with uterine leiomyomas, supra-selective uterine arteries embolization was used. In 97% (n = 1101) of patients, bleeding was stopped after the first attempt of PAE. 3% (n = 34) needed a second embolization. In 12 of 14 cases of AVM, PAE was successful, two other cases needed reintervention; (4) Conclusions: Endovascular procedures represent a major therapy method for both acute and chronic hemorrhage in Obstetrics and Gynecology. It can be used in post-partum or post-traumatic causes of vaginal bleeding, but also in patients with chronic hemorrhage from uterine leiomyomas or inoperable genital malignancies or even as a preoperative adjuvant in cases of voluminous uterine fibroids or invasive malignant tumors, aiming to reduce intraoperative hemorrhage.