子宫两处动静脉瘘合并胚物残留一例  

Two Lesions of Uterine Arteriovenous Fistula Combined with Retained Products of Conception:A Case Report

作　　者：许阡 彭燕蓁[1] 柳鑫 陈曦 XU Qian;PENG Yan-zhen;LIU Xin;CHEN Xi(Gynecology Minimally Invasive Center,Beijing Obstetrics and Gynecology Hospital,Capital Medical University/Beijing Maternal and Child Health Care Hospital,Beijing 100006,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院妇科微创中心,北京100006

出　　处：《国际生殖健康／计划生育杂志》2023年第3期206-210,共5页Journal of International Reproductive Health/Family Planning

摘　　要：报告1例子宫两处动静脉瘘合并胚物残留的病例。该患者因稽留流产刮宫术后,阴道淋漓出血伴阵发性大量出血收入院。入院后行子宫动脉栓塞术,明确诊断子宫动静脉瘘。第2天行宫腹腔镜联合手术,宫腔镜检查发现宫腔内残留胚物样组织,腹腔镜检查发现右侧宫角和左侧宫底近左侧宫角处紫蓝色病灶,表面被覆畸形血管,切除右侧宫角及左侧宫底病灶过程中,可见肌层间管状扩张血管。子宫动静脉瘘可出现阵发性大出血,当其合并胚物残留时,出血风险更高,临床需提高对子宫动静脉瘘合并胚物残留的认识。超声作为首选影像学检查,子宫动脉收缩期峰值血流速度(peak systolic velocity,PSV)大于60~70 cm/s时,需即刻干预。数字减影血管造影(digital subtraction angiography,DSA)是诊断子宫动静脉瘘的金标准,可同时行子宫动脉栓塞术减少出血。术中应仔细探查肌壁间病灶,谨防肌壁间多处动静脉瘘形成,造成漏诊。如子宫动静脉瘘合并胚物残留,宫腹腔镜联合手术可能是推荐治疗方式。A case of the two lesions of uterine arteriovenous fistula combined with retained products of conception was reported.The patient was admitted to hospital with vaginal dripping bleeding with paroxysmal massive bleeding after the curettage of missed miscarriage.Uterine artery embolization was performed after admission.Uterine arteriovenous fistula was definitely diagnosed during the operation.On the second day,hysteroscopy combined with laparoscopy was performed.Hysteroscopy revealed that the embryo residues in the uterine cavity.Laparoscopy revealed that the right cornu uteri protrusion,while the left fundus near the left cornu uteri was locally purple blue lesions.The surface was covered with a large number of malformed blood vessels.During laparoscopic resection of the right cornu uteri and the left fundus lesions,tubular dilated blood vessels between the muscular layers was observed.Uterine arteriovenous fistula appeared a fatal hemorrhage,when combined with embryo residue,the risk of bleeding was higher.Clinical awareness of uterine arteriovenous fistula combined with retained products of conception needs to be improved.Ultrasound is the preferred imaging,and when the peak systolic velocity(PSV)of the uterine artery is greater than 60-70 cm/s,immediate intervention is required.Digital subtraction angiography(DSA)is the gold standard for diagnosing uterine arteriovenous fistula,which can be performed concurrently with uterine artery embolization to reduce bleeding.During surgery,intermural lesions should be carefully explored to prevent the formation of multiple arteriovenous fistulas between the muscles and the missed diagnosis.If uterine arteriovenous fistula is combined with retained products of conception,the combined hysteroscopy and laparoscopy may be the recommended treatment.

关 键 词：子宫疾病 动静脉瘘 妊娠物残留 诊断 治疗 病例报告 

分 类 号：R713.4[医药卫生—妇产科学]