子宫动静脉畸形五例临床分析

Clinical Analysis of Five Cases of Uerine Arteriovenous Malformation

目的:分析子宫动静脉畸形(arteriovenous malformations,AVMs)的病因及临床表现,探讨诊治中的注意事项。方法:回顾分析北京大学第三医院(我院)2014年3月—2018年3月收治的5例子宫AVMs的临床资料,并结合文献讨论。结果:5例经阴道彩色多普勒超声检查初步诊断为子宫AVMs,1例宫腔镜下清宫+宫腔球囊压迫,3个月后复查病变消失;1例超声引导下清宫,3个月后复查病变消失;另外3例经血管造影确诊,同时行选择性子宫动脉栓塞,1例术后2+年成功分娩,1例术后2个月闭经,1例栓塞后清宫,术后3个月复查病变消失。结论:经阴道彩色多普勒超声可作为子宫动静脉畸形的首选检查方法,血管造影是诊断的金标准。选择性子宫动脉栓塞是控制子宫出血的有效方法。

Objective: To analyze the cause and clinical manifestations of uterus arteriovenous malformations(UAVMs), and to discuss the precautions in diagnosis and treatment. Methods:Five patients(accepted from March 2014 to March 2018) were diagnosed as UAVMs by Peking University Third Hospital. The clinical data were retrospectively analyzed. Results:UAVMs were preliminarily diagnosed by ultrasound Doppler examination in five cases. One was treated with hysteroscopic curettage plus uterine balloon oppression, and the lesion disappeared 3 months later. One was treated with the ultrasound-guided curettage, and the lesion also disappeared after 3 months. Three other cases were confirmed by angiography, and treated synchronously with the selective uterine artery embolization. One patient delivered successfully after 2+years. One had amenorrhea after 2 months. The last case had curettage after embolization, and the lesion disappeared 3 months after operation.Conclusions:Color doppler ultrasound through vagina can be adopted as the preferred examination of UAVMs,while angiography remains the golden criteria for diagnosis. Selective uterine artery embolization is an effective treatment of UAVMs.