创伤性子宫动静瘘彩色多普勒超声检测的价值

COLOR DOPPLER ULTRASONOGRAPHY OF TRAUMATIC UTERINE FISTULA AND ITS CLINICAL SIGNIFICANCE

目的 总结创伤性子宫动静瘘彩色多普勒超声表现,探讨创伤性子宫动静瘘彩色多普勒超声表现及其临床意义。方法 回顾性分析医院2005年3月~2015年3月收治的32例创伤性子宫动静脉瘘伴阴道大出血患者的临床资料,并就其发病原因、临床表现、诊断与处理等方面进行了探讨。对其彩色多普勒超声表现及频谱特点进行总结及分析。结果 32例患者既往都有流产或剖腹产史。二维声像图均观察到子宫肌层丰富血流信号,19例呈蜂窝状液性暗区改变,5例为囊性肿物改变,8例为混合性。彩色多普勒超声检查具有极丰富“五彩镶嵌”或“湖泊样”彩色血流,包络线为毛刺状高速低阻或低速低阻,阻力指数小于0.40,静脉血流动脉化子宫动静脉瘘特征性改变。32例中15例例抗炎止血保守治疗成功,14例采取子宫动脉栓塞术后再清宫治愈。3例实施子宫次全切除术,无1例出现严重并发症,所有患者均进行了血人绒毛膜促性腺激素（β-h CG）水平测定,并除外妊娠或妊娠性滋养细胞肿瘤。结论 超声检测用于诊断子宫动静脉瘘具有无创、经济、便捷的特点,诊断率高,结果可靠,可作为首选的检查方法。

Objective To summarize the color Doppler ultrasound findings of traumatic uterine fistula, and to explore the clinical significance of color Doppler ultrasound in traumatic uterine fistula. Methods The clinical data of 32 cases of traumatic arteriovenous fistula associated with vaginal bleeding in our hospital from March 2005 to March 2015 in our hospital were analyzed retrospectively. The causes, clinical manifestations, diagnosis and treatmerit of these patients were discussed. A summary and analysis of the color Doppler ultrasound performance and spectral characteristics were concluded. Results There were 32 cases of abortion or caesarean section. Two - dimensional ultrasounds of them all showed rich blood flow signals in uterine flesh layer, 19 cases showed honeycomb liquid dark area, 5 cases of cystic mass, and 8 cases of mixed type. Color Doppler ultrasound examination showed plentiful ＇ colorful mosaic＇ or ＇ lake like＇ color blood flow; it＇s envelope was burr - like high - speed and low resistance or low - speed and low resistance, with the resistance index less than 0.40 ; and there was changes in venous flow of the u- terine arteriovenous fistula. In 32 cases, 15 were successfully cured with conservative treatment of anti - inflammation and hemostasis ; 14 patients were cured with curettage after uterine artery embolization and 3 cases underwent subtotal hysterectomy without any severe complication. All of these three patients carried out examinations of blood human chorionic gonadotropin （beta -hCG） level determination, and except for pregnancy or gestational trophoblast tumor. Conclusion The ultrasonic detection for the diagnosis of this disease is non - invasive, economical and convenient. The diagnostic rate is high, and the result is reliable. It can be used as the first choice in the diagnosis of uterine arteriovenous fistula.