彩色多普勒超声检查子宫动静脉瘘14例临床分析

Evaluation of color Doppler ultrasonography in diagnosis of arteriovenous fistula resulted from traumatic uterine bleeding

目的探讨子宫创伤所致子宫动静脉瘘患者彩色多普勒超声血流特征及指导临床治疗的价值。方法采用彩色多普勒超声观察14例既往有流产或剖腹产史子宫异常出血患者的子宫血流情况。结果14例创伤性子宫异常出血患者彩色多普勒频谱超声均观察到子宫肌层丰富血流信号;表现为特征性动静脉瘘区五彩镶嵌血流信号,瘘口处探及高速动脉血流频谱3例,表现为肌层回声不均,肌层湖泊样低速低阻血流频谱11例,其中1例动静脉瘘合并假性动脉瘤保守治疗成功;1例单纯子宫动静脉瘘行球囊压迫止血成功;1例子宫动静脉瘘合并宫腔残留,在子宫动脉栓塞后刮宫治愈;另11例抗炎止血保守治疗。结论子宫动静脉瘘是创伤性子宫异常出血的原因之一,彩色多普勒超声可用于其诊断并指导临床治疗和监测治疗效果。

Objective To evaluate color Doppler Sonography in diagnosis and guidance for treatment of arteriovenous fistula （AVF） resulted from traumatic uterine bleeding. Methods Fourteen cases with abnormal uterine bleeding, who had history of pregnancy, short- or long - term uterine operation, delivery, abortion or Caesarean section, underwent color Doppler sonography. The sonographic features and outcome of management were analyzed. Results Abundant blood flow at the myometrium was observed from all 14 cases. The sonographic features were colorful mosaic - like flow at the region of AVF, high - speed artery flow at the opening of AVF. Three cases presented characteristic image as uneven echo at the myometrium, with lake - like, low - speed, low - resistant flow. One AVF with pseudoaneurysm was treated successfully by conservative expectation; one simple AVF by compression haemostasis with ureter saeculus proprius; one AVF with residual by therapeutic embolization followed by curettage; and the other 11 by conservative therapy of anti- inflammatory and medicine haemostasis. Conclusion Arteriovenous fistula is one of the causes of abnormal uterine bleeding resulted from trauma. Color Doppler ultrasonography is valuable in diagnosis of AVF, as well as guidance of treatment and surveillance of the management.