晚期产后出血伴子宫动静脉瘘11例临床分析

Advanced postpartum hemorrhage with uterine arteriovenous fistula:a clinical data analysis of 11 cases

目的探讨晚期产后出血伴子宫动静脉瘘的临床表现、诊断、治疗及预后。方法对浙江大学医学院附属妇产科医院2018年1月至2022年5月期间收治的病理诊断明确为晚期产后出血伴子宫动静脉瘘的11例患者的临床资料进行分析。结果11例患者中,8例有2次及以上妊娠史(72.7%);9例有宫腔操作史(81.8%)。11例患者临床表现多样,产后发生出血时间在其终止妊娠后8~66(31.2±20.1)d,阴道流血呈现出持续性、反复性和突发性。盆腔血管造影下均可见明显病灶。11例均行双侧子宫动脉栓塞术,阴道流血在术后3~6d得到控制。随访中,3例患者因哺乳月经尚未复潮,4例在术后1~4个月月经规律复潮;1例盆腔炎治疗中,月经未复潮;3例患者失访。结论宫腔操作史与获得性子宫动静脉瘘密切相关,阴道流血是常见症状,但缺乏特异性。临床工作应综合考虑患者临床表现、病情发展、个人因素等,早期识别,给予个体化的治疗方案。

Objective To discuss the clinical manifestations,diagnosis,treatment and prognosis of advanced postpartum hemorrhage with uterine arteriovenous fistula by analyzing clinical cases and consulting literature.Methods The clinical data of 11 patients with confirmed pathological dignnosis of advanced postpartum hemorrhage and uterine arteriovenous fistula admitted to the Women's Hospital of School of Medicine of Zhejiang University from January 2018 to May 2022 were analyzed.Results Among the 11 patients,8 patients had two or more pregnancies(72.7%);9 patients had a history of uterine operation(81.8%);1 patient had various clinical manifestations,and the postpartum bleeding time was 8-66(31.2±20.1)days after the termination of pregnancy,and vaginal bleeding was persistent,repetitive and sudden;obvious lesions could be seen under pelvic angiography;bilateral uterine artery embolization was performed,and vaginal bleeding was controlled 3 to 6 days after the operation;in the follow-up,3 patients had not recovered menstruation due to lactation,and 4 cases recovered regular in menstruation 1 to 4 months after surgery.Conclusions The acquired uterine arteriovenous fistula is closely related to the history of uterine operation.Vaginal bleeding is a common symptom of uterine arteriovenous fistula but lacks specificity.Clinical staff should comprehensively consider the patient's clinical manifestation,disease development and personal factors,identify conditions early,and implement the personalized treatment plan.