2022 年第 6 期 第 17 卷

子宫动静脉瘘的临床特点与诊治分析

Clinical characteristics, diagnosis and treatment of uterine arteriovenous fistula

作者：王焕英魏炜徐晓辉包照亮张军

英文作者：Wang Huanying Wei Wei Xu Xiaohui Bao Zhaoliang Zhang Jun

单位：首都医科大学附属北京安贞医院妇产科，北京100029

英文单位：Department of Obstetrics and Gynecology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：子宫动静脉瘘；阴道出血；彩色多普勒超声

英文关键词：Uterinearteriovenousfistula;Vaginalhemorrhage;ColorDopplerultrasound

• 摘要：

• 目的 探讨子宫动静脉瘘（UAVF）的临床特点、诊断与治疗方法。方法 回顾性分析2012年1月至2021年8月在首都医科大学附属北京安贞医院妇产科收治的9例UAVF患者的临床资料。结果 9例UAVF患者均有不同次数的既往妊娠、子宫手术或感染史。7例患者表现突发突止的阴道大量出血，其中反复出现者6例。出现临床症状的时间距前次妊娠或宫腔操作史＜1个月的为5例，≥1个月的为3例。9例患者均经彩色多普勒超声检查诊断。1例保守治疗，8例手术治疗，包括1例超声监测下清宫术+宫腔球囊压迫术，1例二次双侧子宫动脉栓塞术，3例超声或腹腔镜监测下宫腔镜UAVF电切术，1例腹腔镜全子宫切除术，2例多种方法综合治疗。结论 阴道出血是UAVF患者的常见症状，彩色多普勒超声是诊断UAVF的首选方法。提高早期识别和诊断UAVF的能力，根据患者的综合情况制定合适的治疗方案可为患者带来最好的治疗效果和最小的损伤。

• Objective To study the clinical characteristics, diagnosis and treatment of uterine arteriovenous fistula（UAVF）. MethodThe clinical data of 9 patients with UAVF admitted to Beijing Anzhen Hospital, Capital Medical University from January 2012 to August 2021 were retrospectively analyzed. Results   All patients had a history of different times of previous pregnancy, uterine cavity operation or inflection. Seven patients had sudden and punctuated massive vaginal hemorrhage, and 6 cases of which occurred repeatedly. Five cases presented with clinical symptoms within 1 month of last pregnancy or intrauterine operation and 3 cases presented over 1 month. All the patients were diagnosed by color Doppler ultrasonography. One case was treated conservatively, and other eight cases were treated surgically, including 1 case of uterine curettage under ultrasonic monitoring and uterine balloon compression, 1 case of secondary bilateral uterine artery embolization, 3 cases of hysteroscopic electroresection of UAVF under ultrasonic or laparoscopic monitoring, 1 case of laparoscopic total hysterectomy, and 2 cases of comprehensive treatment with various methods. Conclusions  Vaginal hemorrhage is a common symptom in patients with UAVF. Color Doppler ultrasound is the first choice for the diagnosis of UAVF. We need to improve the ability of early identification and diagnosis of UAVF, and formulate appropriate treatment plans according to the comprehensive situation of patients, so as to bring the best treatment effect and minimum damage to patients.