子宫动脉栓塞术治疗子宫动静脉畸形伴晚期产后出血16例  

Uterine arterial embolization for the treatment of uterine arteriovenous malformation with late postpartum hemorrhage: clinical analysis of 16 patients

作　　者：左坤[1] 郑煜坤[2] 陈德 康亚辉 赵有红[1] 刘晓丽[1] ZUO Kun;ZHENG Yukun;CHEN De;KANG Yahui;ZHAO Youhong;LIU Xiaoli(Gansu Provincial Maternal and Child Health Hospital,Lanzhou,Gansu Province 730050,China)

机构地区：[1]甘肃省妇幼保健院,兰州730050 [2]兰州大学第一医院妇产科

出　　处：《介入放射学杂志》2019年第10期978-981,共4页Journal of Interventional Radiology

摘　　要：目的探讨子宫动静脉畸形(AVM)伴晚期产后出血(LPH)的临床特点及治疗方式。方法回顾性收集2012年3月至2017年3月甘肃省妇幼保健院采用子宫动脉栓塞术(UAE)治疗的16例子宫AVM伴LPH患者临床资料,分析其临床特点、治疗效果和预后。结果16例患者妊娠次数1~6次,平均(2.3±1.25)次,其中首次妊娠1例,2~4次13例,≥5次2例。本次妊娠引产和自然分娩12例,剖宫分娩4例。16例中10例有宫腔操作史,其中≥2次者4例;LPH发病时间为产后5~43 d,其中突发阴道大量流血6例,并发失血性休克2例;出血量>1000 mL7例,间歇性子宫出血9例;均有不同程度贫血,需输血4例。盆腔动脉DSA造影显示双侧子宫动脉瘘3例,单侧子宫动脉瘘11例,子宫动脉假性动脉瘤2例。16例患者均接受UAE,术后予宫腔镜下病灶电切术5例,清宫术2例,子宫切口二次修补术1例,子宫切除术2例。所有患者预后良好。结论子宫AVM可能是LPH发病因素之一。胎盘植入、手术创伤、子宫切口愈合不良和感染等均可引起子宫AVM发生,从而导致LPH。UAE是治疗子宫AVM伴LPH有效方法。产后积极处理残留胎盘组织,评估切口愈合状况并予干预,可降低再出血风险,避免子宫切除等不良事件发生。Objective To discuss the clinical features and treatment of uterine arteriovenous malformation(AVM)associated with late postpartum hemorrhage(LPH).Methods The clinical data of 16 patients with uterine AVM complicated by LPH,who were admitted to Gansu Provincial Maternal and Child Health Hospital of China to receive uterine arterial embolization(UAE)during the period from March 2012 to March 2017,were collected.The clinical features,therapeutic effect and prognosis of the patients were retrospectively analyzed.Results In the16 patients,the number of pregnancies was 1-6 times,with a mean of(2.30-1.25 times),including first pregnancy(n=1),2-4 times of pregnancy(n=13),≥5 times of pregnancy(n=2).Twelve patients had induced labour or natural childbirth,4 patients underwent caesarean delivery.Of the 16 patients,10 had the history of hysteroscopic surgery,4 of them underwent the surgery two or more times.The onset of LPH was within 5-43 days after delivery.Sudden vaginal bleeding was seen in 6 patients and hemorrhagic shock was complicated in 2 of them.The amount of blood loss>1000 mL was seen in 7 patients and intermittent uterine bleeding was observed in 9 patients.Anemia of varying degrees was found in all patients,and 4 patients needed blood transfusion.Pelvic arteriography with DSA demonstrated that there were bilateral uterine artery fistula(n=3),unilateral uterine artery fistula(n=11)and uterine artery pseudoaneurysm(n=2).All of the 16 patients underwent UAE.After UAE,5 patients received hysteroscopic electrocision of lesion,2 patients received uterine curettage,one patient received secondary repair of uterine incision and 2 patients received hysterectomy.All patients had a good prognosis.Conclusion Uterine AVM may be one of the factors contributing to LPH.Placental implantation,surgical trauma,poor healing of uterine incision and infection can cause the occurrence of uterine AVM,resulting in LPH.UAE is an effective treatment for uterine AVM complicated by LPH.After childbirth,active management of residual place

关 键 词：晚期产后出血 子宫动静脉畸形 盆腔血管栓塞 子宫切除 

分 类 号：R714[医药卫生—妇产科学]