不全流产继发子宫动静脉瘘16例临床分析  

Clinical analysis of 16 women with secondary uterine arteriovenous fistula caused by incomplete abortion

作　　者：徐硕 李长东[1] XU Shuo;LI Changdong(Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing , 100026)

机构地区：[1]首都医科大学附属北京妇产医院,北京妇幼保健院,100026

出　　处：《中国计划生育学杂志》2021年第10期2101-2104,共4页Chinese Journal of Family Planning

摘　　要：目的:分析不全流产继发子宫动静脉瘘(UAVF)病例的临床特点、诊断及治疗。方法:回顾分析2016年1月—2020年10月本科收治的16例不全流产继发UAVF病例临床资料。结果:流产至发病时间为(67.1±28.4)d,15例有不同程度的阴道出血,其中7例因突发阴道大出血急诊入院。超声显示包块直径为(34.0±11.8)mm,RI(0.3±0.2);血β-hCG 20.6(4.8~119.0)U/L,入院血红蛋白(106.8±21.3)g/L。15例行UAEF宫腔镜手术,1例UAE后行开腹全子宫切除术。术中发现残留胚物位置异常者6例,术后病理均可见不同程度退变的绒毛组织。保守或期待治疗过程中发生阴道大出血的病例特点:流产时孕周及残留胚物直径较大、多合并流产相关并发症、血红蛋白水平更低、住院天数更长(P<0.05)。结论:不全流产胚物残留时可发生UAVF,对流产孕周及残留胚物较大时,以及合并流产相关并发症者应警惕阴道大出血的发生;UAE术后宫腔镜下病灶切除是一种安全有效的治疗方法。Objective:To analyze the clinical characteristics,diagnosis,and treatment of the women with secondary uterine arteriovenous fistula(UAVF)caused by incomplete abortion.Methods:The clinical data of 16 women with secondary UAVF caused by incomplete abortion from January 2016 to October 2020 were analyzed retrospectively.Results:The duration from abortion to UAVF onset was(67.1±28.4)d,and there were 15 women with different degree of vaginal bleeding,and among them,there were 7 women were emergency admission due to sudden vaginal profuse bleeding.The mass size and RI by ultrasound were 34.0±11.8 mm and 0.3±0.2.The bloodβ-HCG level of these women was 20.6(4.8-119.0)U/L,and the hemoglobin of these women when admission was 106.8±21.3g/L.There were 15 women had undergone uterine artery embolization(UAE)and hysteroscopy,and only one of them then had undergone total open hysterectomy after UAE.6 women were found as the abnormal position of residual embryo,and the degeneration of villi tissues of these 6 women were found in postoperative pathology.The characteristics of patients with vaginal hemorrhage during conservative or expectant treatment included larger gestational age and residual embryo diameter,more abortion-related complications,lower hemoglobin level and longer hospital stay(P<0.05).Conclusion:UAVF of the women maybe occur when embryonic remains after incomplete abortion.The vaginal profuse bleeding of the women with higher gestational weeks when abortion,the women with more residual embryo,or the women with abortional complication should be guarded carefully.Hysteroscopic lesion resection after UAE for these women is one kind of safe and effective treatment.

关 键 词：不全流产 子宫动静脉瘘 胚物残留 宫腔镜手术 

分 类 号：R71[医药卫生—妇产科学]