妊娠滋养细胞肿瘤子宫动静脉瘘的临床分析  

Clinical analysis of uterine arteriovenous fistula following gestational trophoblastic neoplasia

作　　者：樊蓓[1] 韩超[1] 王雁[1] 张晓峰[2] 徐小红[1] 

机构地区：[1]首都医科大学附属北京妇产医院妇瘤科,100006 [2]首都医科大学附属北京妇产医院放射科,100006

出　　处：《北京医学》2017年第11期1111-1113,1118,共4页Beijing Medical Journal

摘　　要：目的探讨妊娠滋养细胞肿瘤子宫动静脉瘘的临床特点、影像学检查、治疗和预后,为临床提供指导。方法回顾性分析北京妇产医院2010-2016年确诊的15例妊娠滋养细胞肿瘤子宫动静脉瘘患者的临床资料。结果患者平均年龄33.9岁(23~51岁),平均孕次2.6次(0~5次)。53.3%的妊娠滋养肿瘤子宫动静脉瘘来源于完全性葡萄胎。14例患者(93.3%)出现症状,呈现慢性或急性异常阴道出血。14例患者的人绒毛膜促性腺激素(HCG)水平升高,而1例患者在诊断时HCG水平无法检测。彩色多普勒超声检查是常用的筛查方法,但最终诊断的金标准是盆腔血管造影。选择性子宫动脉栓塞是最常见的治疗方法。5例成功栓塞子宫的患者怀孕。结论妊娠滋养细胞肿瘤反复原因不明的异常阴道出血,应考虑子宫动静脉瘘的诊断。盆腔血管造影检查、选择性子宫动脉栓塞术是诊断、治疗子宫动静脉瘘优先考虑的方法,对妊娠无明显不良影响。Objective To explore the clinical characristics, imaging, management and prognosis of uterine arterio- venous fistula. Methods Fifteen cases diagnosed with uterine arteriovenous fistula in Beijing Obstetrics and Gynaecolo- gy Hospital from 2010 to 2016 were retrospectively analyzed. Results The median age of women diagnosed with uterine arteriovenous fistula was 33.9 years old （23-51）. The median gravidity was 2.6 （0-5）. Complete molar pregnancy was the most common initial gestational trophoblastic diagnosis （53.3%）. Overall, 14 patients （93.3%） were symptomatic and pre- sented with chronic or acute abnormal vaginal bleeding. Fourteen patients had elevated HCG level while 1 patient had an undetectable HCG level at the time of uterine AVF diagnosis. Color Doppler ultrasound was the commonly used screening method, but the gold standard for definitive diagnosis of the disease was angiographic examination. Uterine artery emboli- zation was the most common treatment option for these patients. Five patients were pregnant after successful embolization of uterine, most of the pregnancies were successful. Conclusion The diagnosis of uterine arteriovenous fistula should al- ways be considered in patients with a history of recurrent unexplained vaginal bleeding after gestational trophoblastic neo- plasia. Angiographic embolization is successful in the majority of cases and does not appear to compromise future preg- nancy.

关 键 词：子宫 动静脉瘘 妊娠滋养细胞肿瘤 

分 类 号：R737.3[医药卫生—肿瘤]