A Clinical Analysis Of Transcatheter Arterial Embolization Compared With Hysterectomy In The Treatment Of Intractable Postpartum Hemorrhage

Objective: To evaluate the clinical value of transcatheter arterial embolization in the treatment of intractable postpartum hemorrhage compared with hysterectomy. Methods: Clinical data of 38 patients with intractable postpartum hemorrhage including 31 cases with spontaneous postpartum and 7 cases with postcesarean bleeding hospitalized from September 2004 to November 2007 in the First affiliated hospital of Nanchang University were retrospectively analyzed.All patients were divided into two groups by different hemostasia ways, research group underwent femoral artery puncture by Seldinger,s technique,the age of the patients ranged between 21 and 37 years with a mean age of (27.10±3.91) years and the number was 20,a 5F Cobra catheter was used with a hydrophilic polymer-coated 0.035 inch guidedwire, superselectiv catheterization to the bilateral internal iliac arteries or uterial arterial and internal iliac arteries embolization(IIAE) or uterial arterial embolization(UAE) with gelfoam particles was followed after the bleeding sources was proved by digital substraction angiography(DSA) techniques; control group was treated by hysterectomy including total hysterectomy and supercervical hysterectomy,the age of the patients ranged between 22 and 35 years with a mean age of (28.11±3.72) years and the number was 18.The following items were investigated: the effective power of haemostasis,operating time,stayearlier out-of-bed activity and median postoperative hospital.Results:1,Twenty cases in research group were performed successfully while a conversion to hysterectomy was required in one case because of bleeding on the secong day after operation. effective power of haemostasis was 95% in research group,which was 94.4% in control group, comparison between two group showned that difference had not statistical significance(P=0.73).2,Operation time,earlier out-of-bed activity and median postoperative hospital stay in research group were (48.80±9.92)min,(3.10±1.12)d,(8.45±2.01)d respectively, those were (84.22±8.76)min,(4.33±1.19)d,(13.11±2.28)d respectively in control group, research group was significantly shoter than control group, the difference had statistical significance(P<0.01,P=0.01,P<0.01). Hysterectomia rate was 5% in research group, which was 100% in control group, research group was significantly less than control group,3,Nineteen patients were followed up for nine months in research group, fifteen women resumed normal menstruation,moreover one woman got re-pregnant and successfully given birth to a child.Conclusion:1,The clinical effect has not defferent between transcatheter arterial embolization and hysterectomy in the treatment of intractable postpartum hemorrhage and two treated methods were all effective2,Compared to hysterectomy, transcatheter arterial embolization has many advantages including minimal trauma,less postoperative dysfunction,shorter hospital stay and Uterus and its physiological function were reserved.3,Transcatheter arterial embolization is a new way to the treatment of intractable postpartum hemorrhage,it deserves to spread and utilize in the conditioned hospital. But sometimes hysterectomy is still required.