晚期产后出血并子宫动静脉瘘1例报道及相关文献复习

A Case Report of Late Postpartum Hemorrhage and Uterine Arteriovenous Fistula and Related Literature Review

目的:总结子宫动静脉瘘的疾病特点,为临床诊治提供依据。方法:回顾性分析我院2021年12月收治的1例晚期产后出血并子宫动静脉瘘患者的临床资料,并结合相关文献进行分析总结。患者女性,27岁,因“产后40天,阴道流血4天”来诊我院,入院后B超提示:宫腔内不均质回声,范围约2.4 ×2.8 ×1.3 cm,其内见1.4 ×0.7 cm无回声,子宫后壁肌层血流信号丰富,考虑子宫动静脉瘘可能。患者入院1天后突发阴道流血,量约1500 ml,伴神志淡漠,心率快,血压低,考虑失血性休克。结果:予以急行宫腔球囊压迫止血后行急诊行双侧子宫动脉栓塞术,手术顺利,术后予以一般对症补液支持治疗,患者于术后3天顺利出院,患者现术后4月随访,一般状况好。结论:子宫动静脉瘘是血流异常性疾病,疾病表现凶险,在临床中收治无法明确诊断的产后阴道流血患者时应考虑此病;B超对子宫动静脉瘘诊断具有一定价值,子宫血管造影是确诊方法,介入治疗后可使用药物预防复发并密切随访。

Objective: To summarize the disease characteristics of uterine arteriovenous fistula and to provide a basis for clinical diagnosis and treatment. Methods: The clinical data of a patient with late postpartum hemorrhage and uterine arteriovenous fistula admitted to our hospital in December 2021 were retrospectively analyzed, and summarized in combination with relevant literature. The patient woman, 27 years old, came to our hospital because of “40 days after delivery, 4 days of vaginal bleeding”, and after admission, ultrasound B prompted: intrauterine uneven echo, ranging from about 2.4 ×2.8 ×1.3 cm, its internal view was 1.4 ×0.7 cm without echo, and the blood flow signal of the muscular layer of the posterior wall of the uterus was abundant, considering the possibility of uterine arteriovenous fistula. The patient suddenly suffered vaginal bleeding 1 day after admission, the amount was about 1500 ml, accompanied by apathy, rapid heart rate, low blood pressure, and hemorrhagic shock was considered. Results: Bilateral uterine artery embolization was performed in the emergency department after emergency uterine balloon compression and hemostasis, the operation was smooth, and the general symptomatic rehydration support treatment was given after the operation. The patient was successfully discharged from the hospital 3 days after the operation. The patient is now followed up 4 months after surgery, and the general condition was good. Conclusions: Uterine arteriovenous fistula is an abnormal blood flow disease with dangerous disease manifestations, which should be considered when treating patients with postpartum vaginal bleeding that cannot be clearly diagnosed clinically;Ultrasound B has certain value for the diagnosis of uterine arteriovenous fistula, hysterogram is the method of diagnosis, and drugs can be used to prevent recurrence and follow up closely after interventional treatment.