산후출혈의 치료를 위한 동맥색전술의 실패와 관련된 인자의 분석
Analysis of failed arterial embolization for postpartum hemorrhage
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목적: 산후출혈로 동맥색전술을 시행한 환자들을 분석하여 동맥색전술의 실패의 원인과 관련된 인자들에 대하여 알아보고자 하였다. 연구 방법: 2004년부터 2008년까지 고려대학교 의료원에서 산후출혈로 동맥색전술을 시행한 60명의 환자의 진료 기록과 동맥조영술 결과를 후향적으로 분석하여 성공군과 실패군을 비교하였다. 결과: 동맥색전술의 전체 성공률은 88.3% (53/60명)였고 실패한 경우는 11.7% (7/60명)였다. 색전술의 실패는 비정상태반인 경우 통계적으로 유의하게 높았으며 (P=0.034), 특히 태반 유착이 동반된 전치태반의 경우에서 더욱 그러하였다 (P=0.009). 각 대상군의 나이, 분만력, 분만 방법, 출혈시기, 전원 여부, 시술 전 수술 여부, 시술 시 활력징후, 시술 전 혈색소 수치, 분만 후 색전술까지 시간, 중환자실 치료 여부 등은 차이가 없었다. 결론: 산후출혈 환자에서 동맥색전술은 성공률이 높고 합병증이 적은 안전한 시술 방법이나 출혈의 원인이 비정상태반인 경우 동맥색전술이 실패할 가능성이 높다.
Abstract
Objective: To investigate what factors are associated with a failed arterial embolization for postpartum hemorrhage (PPH) and to attempt to estimate efficacy of arterial embolization. Methods: Between 2004 and 2008, 60 patients at Korea University Medical Cencter underwent arterial embolization to control obstetrical hemorrhage. In all cases, arterial embolization was performed because of intractable hemorrhage unresponsive to conservative management. Medical records and angiographic results were reviewed. Arterial embolization failure was defined as the requirement for subsequent surgical procedure to control PPH with the procedure, and its results. Results: Arterial embolization was attempted in 60 of deliveries. Failures occurred in 7 of 60 cases (11.7%) and in 4 of 7 cases (57.1%) of abnormal placentation (placenta previa totalis with or without placenta accrete or increta). Comparison of the failed and successful arterial embolization groups showed no differences in maternal characteristics, clinical status, and angiographic finding. Amount of total transfusion in failed arterial embolization group were larger than successful group although hemoglobin before embolization was not different. Conclusion: The only factor significantly associated with failed arterial embolization was an abnormal placentation. Arterial embolization is a safe and highly effective method to control PPH.
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