误诊为功能性子宫出血的子宫血管瘤三例临床分析  

Clinical Analysis of 3 Patients with Uterine Hemangioma Misdiagnosed As Having Dysfunctional Uterine Bleeding

作　　者：尹家瑶 杨滢 叶智慧 伍天慧 许兴艳 张敏[1] 

机构地区：[1]汉中3201医院妇科门诊部,陕西汉中723000

出　　处：《临床误诊误治》2017年第11期25-28,共4页Clinical Misdiagnosis & Mistherapy

基　　金：陕西省科技攻关项目(2013G17)

摘　　要：目的探讨子宫血管瘤的临床特点及其误诊为功能性子宫出血的原因、防范措施。方法对曾经误诊为功能性子宫出血的子宫血管瘤3例的临床资料进行回顾性分析。结果 3例分别因头晕、心悸、恶心伴阴道大量不规则出血3 h、月经量增多6月余及阴道不规则出血3 h入院。入院后行尿妊娠试验及彩色多普勒超声、宫腔镜、凝血功能等检查均未见异常,诊断为功能性子宫出血。给予相应治疗,患者病情缓解不明显。后经复查彩色多普勒超声或行三维阴道彩色多普勒超声、彩色多普勒血流成像,结合病史及临床表现确诊为子宫血管瘤。2例行双侧子宫动脉造影联合右侧子宫动脉栓塞术治疗,1例在宫腔镜引导下行阴式全子宫切除术治疗。术后观察1周3例均无阴道出血,予以出院。现2例恢复正常月经2和3次。结论子宫血管瘤临床常表现为阴道不规则出血,缺乏特异性,易误诊为功能性子宫出血。提高对该病认识,合理应用超声、宫腔镜及子宫血管造影等检查可提高子宫血管瘤诊断率。Objective To investigate clinical characteristics and preventive measures of uterine hemangioma misdiagnosed as dysfunctional uterine bleeding. Methods Clinical data of 3 patients with uterine hemangioma misdiagnosed asdysfunctional uterine bleeding was retrospectively analyzed. Results Three patients were admitted for dizziness,palpitationand nausea combined with a large number of irregular bleeding in vagina for more than 3 h,more than 6 months of increasedmenstruation and 3 h of irregular bleeding in the vagina. After admission,no abnormality was found by examinations such asurine pregnancy test,color Doppler,hysteroscopy and blood clotting function,was and then dysfunctional uterine bleeding wasdiagnosed. The patients ＇ conditions were not obviously relieved after corresponding treatment. The uterine hemangioma wasconfirmed after review of color Doppler ultrasound or 3d vaginal color Doppler ultrasound and color Doppler flow imaging combined with history and clinical manifestations. Two patients were treated with bilateral uterine arteriography combined withright uterine artery embolization,and 1 patient was treated with hysteroscopeguided vaginal hysterectomy. No vaginal bleedingwas observed in 3 patients after operation by postoperative 1 week of observation,and the patients were discharged. Now 2 patients had been returned to normal menstruation for 2 and 3 times. Conclusion Clinical manifestations of uterine angioma areirregular bleeding in vagina and lack of specificity,and therefore it is easily be misdiagnosis as dysfunctional uterine bleeding.The diagnosis rate of the disease can be improved by improving the understanding,reasonablely using examinations such as ultrasonography,hysteroscopy and angiography.

关 键 词：血管瘤 子宫 误诊 功能性子宫出血 

分 类 号：R737.33[医药卫生—肿瘤]