微创止血策略在产科旨在保护子宫功能和提高后续妊娠的安全性

IF 0.4 Q4 OBSTETRICS & GYNECOLOGY
S. Takeda, J. Takeda, S. Makino
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引用次数: 8

摘要

许多尝试和错误的方法已采取实现有效止血难治性产科子宫出血病例。在产科领域,经导管动脉栓塞术(TAE)被认为是控制子宫出血和血肿非常有效的方法。该方法止血率高,子宫切除术的频率因此急剧下降。虽然剖宫产术中大出血的动脉结扎术由于侧支循环通路丰富,在许多情况下可能无法控制出血,但各种新的止血技术如子宫压迫缝合、纱布或球囊填塞子宫、术中TAE等已经出现。然而,即使在使用可吸收栓塞的TAE成功止血的病例中,也有并发症,包括随后的子宫内膜发育不全、月经紊乱、不孕症、妊娠丢失、胎盘增生和子宫破裂。在此背景下,我们重新考虑在这种情况下保留生育能力的产科出血止血策略,并在此讨论如何根据我们对各种止血程序的知识和经验选择最佳策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A minimally invasive hemostatic strategy in obstetrics aiming to preserve uterine function and enhance the safety of subsequent pregnancies
Numerous trial-and-error approaches have been taken to achieve effective hemostasis for difficult obstetrical uterine hemorrhage cases. In the field of obstetrics, transcatheter arterial embolization (TAE) is known to be highly effective for controlling uterine hemorrhage and hematoma. This procedure achieves a high hemostasis rate, and the frequency of hysterectomy has thus sharply decreased. Although arterial ligation for massive hemorrhage at the time of cesarean section may fail to control bleeding in a number of cases due to an abundance of collateral circulation pathways, various new hemostatic techniques such as compression sutures of the uterus, uterine tamponade with gauze or a balloon, and intraoperative TAE have become available. However, complications including subsequent endometrial hypoplasia, menstruation disorder, infertility, pregnancy loss, placenta accreta, and uterine rupture have been reported even in cases undergoing successful hemostasis with TAE using absorbable embolus. Against this backdrop, we reconsidered fertility-preserving hemostatic strategies for critical obstetrical hemorrhage under these circumstances, and herein discuss how to select the optimal strategy based on our knowledge of and experience with various hemostatic procedures.
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来源期刊
Hypertension Research in Pregnancy
Hypertension Research in Pregnancy OBSTETRICS & GYNECOLOGY-
自引率
50.00%
发文量
18
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