子宫动静脉瘘致阴道大出血的临床分析

Diagnosis and management of uterine arteriovenous fistula with massive vaginal bleeding

目的 探讨子宫动静脉瘘致阴道大出血患者的临床特点、诊断与治疗方法以及预后。方法 对我院 1990年 8月至 2 0 0 3年 5月收治的 15例子宫动静脉瘘患者的临床资料进行回顾性分析。结果 本组患者都以异常阴道大量出血就诊 ,15例均合并剖宫产分娩史、多次刮宫史或妇科恶性肿瘤病史。彩色B超及选择性子宫动脉造影通常可以明确诊断。诊断性刮宫并不能起到有效治疗作用 ,反而会加重出血。 15例患者中 ,14例接受子宫动脉栓塞术 ,其中 11例 (79% )栓塞治疗成功 ,栓塞术后无并发症发生。保守治疗成功的患者术后均能恢复正常月经 ,并有 5例成功妊娠。结论子宫动静脉瘘是导致阴道大出血的少见却严重的原因之一 ,子宫动脉栓塞术是治疗子宫动静脉瘘出血有效的保守治疗方法 ,栓塞术后患者的子宫及卵巢功能并不受影响。

Objective To study the clinical manifestation,diagnosis,management and prognosis of uterine arteriovenous fistula with massive vaginal bleeding Method The clinical records of 15 patients who satisfied the diagnostic criteria were retrospectively analyzed Results All patients had massive vaginal bleeding, with a history of caesarean section, curettage or gynecologic carcinoma The disease could be diagnosed by angiography or color Doppler ultrasound Vaginal bleeding was aggravated by dilation and curettage Fourteen patients were treated with uterine artery embolization, and no complications occurred postembolization Of the eleven successful embolizations,all patients returned normal menstrual cycling Five of these patients became pregnant later Conclusions Uterine arteriovenous fistula is a rare and potentially life threatening disease Uterine artery embolization is a safe and effective treatment for this disease, and it can preserve normal function of uterus and ovaries