子宫动静脉瘘1例报道及相关文献复习

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2019年5月收治的1例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,以“异常阴道流血4 d”为主诉就诊,曾于2018年8月行人工流产钳刮术一次。实验室检查示血红蛋白74 g/L,红细胞压积21.8%;行盆腔三维超声、彩色多普勒血流显像及盆腔增强MRI,结合患者病史初步诊断子宫动静脉瘘。结果行子宫动脉造影术确认子宫动静脉瘘病灶,遂行双侧子宫动脉栓塞术。手术过程顺利,术后1 h出现下腹部疼痛,予静脉注射止痛药物氟比洛芬酯50 mg后好转。术后观察2 d,无阴道流血等异常。术后予GnRH-a药物3.75 mg肌肉注射3次,后口服避孕药物屈螺酮炔雌醇片,预防子宫动静脉瘘复发。每个月门诊随访,现患者出院7个月,停用GnRH-a药物后月经恢复正常,未出现异常阴道流血症状,术后5个月时复查盆腔三维超声未见异常。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异常阴道流血患者时应考虑此病;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。

Diagnosis and Treatment of Uterine Arteriovenous Fistula:A Case Report and Associated Literature Review

Objective To summarize the disease characteristics of uterine arteriovenous fistula and provide evidence for clinical diagnosis and treatment.Methods The clinical data of one case of uterine arteriovenous fistula admitted to our hospital in May 2019 were analyzed retrospectively.The female patient,27 years old,presented with"abnormal vaginal bleeding for 4 days"as the chief complaint.The case was performed an abortion in August 2018.The laboratory tests showed hemoglobin of 74g/L and hematocrit of 21.8%.Based on the exam results of pelvic three-dimensional ultrasound,color Doppler flow imaging and pelvic enhanced MRI combined with the patient's medical history,uterine arteriovenous fistula was preliminarily diagnosed.The relevant literature of uterine arteriovenous fistula was reviewed.Results Uterine arteriovenous fistula was confirmed by uterine arteriography,and bilateral uterine artery embolization was performed.The operation was successful.The lower abdominal pain occurred 1 hour after the operation and was relieved by intravenous injection of 50 mg of flurbiprofen.No abnormal vaginal bleeding was observed during the 2 days after the surgery.GnRh-a drug 3.75 mg was injected for 3 times,followed by oral contraceptive drug to prevent the recurrence of uterine arteriovenous fistula.Outpatient follow-up was conducted every month.Now the patient was discharged from the hospital for 7 months.After the withdrawal of GnRh-a drug,her menstruation returned to normal without abnormal vaginal bleeding symptoms.Conclusions Uterine arteriovenous fistula is an abnormal blood flow disease with dangerous manifestations.It should be considered to the patient with abnormal vaginal bleeding cannot be clearly diagnosed.Uterine angiography is the definite diagnostic method,and drugs and close follow-up is necessary to prevent the recurrence after interventional therapy.