子宫动静脉瘘致产褥期阴道出血 10例分析

目的 探讨子宫动静脉瘘（UAVF）致产褥期阴道出血的临床特点、诊治方法及预后。方法 回顾性分析2016年1月至2022年6月四川锦欣西囡妇女儿童医院、西南交通大学附属医院及西南医科大学附属医院诊治的10例UAVF致产褥期阴道出血的临床资料并总结国内外相关文献。结果 病人年龄范围为21～36岁，平均28.5岁；均有子宫手术操作史，包括人工流产、剖宫产、子宫肌瘤挖除及宫腔镜手术史；此次妊娠7例行剖宫产术；出血量范围为600～2 000 mL，平均1 210 mL；阴道出血距离分娩时间范围为3 h至5周；1例经病理检查确诊，5例经彩色多普勒超声（CDU）确诊，4例经数字减影血管造影（DSA）确诊。6例输注血液制品；1例行全子宫切除术，9例行选择性子宫动脉栓塞术，治疗后阴道出血均停止。随访9例保留子宫病人，均未复发，月经正常来潮，其中2例病人再次妊娠；随访时间0.5～5.7年。结论 UAVF致产褥期阴道出血临床少见，但出血量多，易发展成失血性休克，发病与既往子宫手术操作史相关，诊断依赖于CDU、DSA等影像学检查，治疗以保留生育的选择性子宫动脉栓塞术为主，疗效确切，不影响月经情况及生育功能。

Clinical analysis of 10 cases of puerperal vaginal bleeding caused by uterine arteriovenous fistula

Objective To investigate the clinical features, diagnosis, treatment, and prognosis of puerperal vaginal bleeding causedby uterine arteriovenous fistula (UAVF).Methods The clinical data of 10 cases of vaginal bleeding during puerperium due to UAVFin Jinxin Xinan Women and Children''s Hospital, Affiliated Hospital of Southwest Jiaotong University and Affiliated Hospital of South.west Medical University from January 2016 to June 2022 were retrospectively analyzed and the related literatures at domestic andabroad were summarized.Results Patients ranged in age from 21 to 36 years, with a mean of 28.5 years All cases had a history of uter.ine surgery, including artificial abortion, cesarean section, myomectomy, and hysteroscopic surgery. This pregnancy was terminated bycesarean section in 7 cases. The mean blood loss was 1 210 mL (range, 600-2 000 mL). The vaginal bleeding after delivery time was 3hour to 5 weeks. One case was diagnosed by pathological examination, 5 cases were diagnosed by color doppler ultrasound (CDU), and4 cases were diagnosed by digital subtraction angiography (DSA). Six cases were transfused with blood products. Total hysterectomywas performed in 1 case and selective uterine artery embolization was performed in 9 cases. Vaginal bleeding stopped after treatment inall cases. Follow-up of 9 cases with the retained uterus, there was no recurrence, all cases had normal menstruation, of which 2 caseswere pregnant again. The follow-up time was 0.5 years to 5.7 years.Conclusions Puerperal vaginal bleeding caused by UAVF is rarein clinic, but the amount of bleeding is large and easy to develop into hemorrhagic shock, which is related to the history of previous uter.ine surgery. The diagnosis depends on imaging examinations such as CDU and DSA. The treatment is mainly selective uterine arteryembolization with fertility preservation. The curative effect is definite, and it does not affect menstruation and reproductive function.