子宫动静脉瘘引起晚期产后出血的诊疗进展

doi:10.12280/gjfckx.20200541

摘要/Abstract

摘要：

子宫动静脉瘘（uterine arteriovenous fistula,UAVF）是一种临床上较为罕见的子宫血管异常疾病,是导致女性晚期产后出血的原因之一。近年来随着我国二孩政策的放开以及人工流产率的增高,UAVF的发病率也随之上升,严重影响女性的生活质量,并增加了患者再次妊娠的难度和风险。由于UAVF病因和临床表现的多样性,临床工作中常常难以早期识别并及时作出恰当的处理,从而导致不良事件的发生。目前对于UAVF的诊断主要依靠影像学手段,血管造影是金标准。保守治疗、介入治疗和手术治疗是主要的治疗方法,其中子宫动脉栓塞术最常用,但有关对再妊娠不良影响的报道也逐年增多。根据患者的临床症状和生育意愿选择合理的诊疗方案可以改善预后,并减少再次妊娠的风险。

关键词: 子宫, 动静脉瘘, 产后出血, 诊断, 治疗

Abstract:

Uterine arteriovenous fistula (UVAF) is a kind of rare abnormal uterine vascular disease, which is one of the causes of late postpartum hemorrhage in women. In recent years, with the opening of the two-child policy and the increase of the rate of artificial abortion, the incidence rate of UAVF has also increased, which seriously affects the quality of life of women and increases the difficulty and risk of the second pregnancy. Due to the diversity of etiology and clinical manifestations of UAVF, it is often difficult to identify early and make appropriate treatment in clinical work, which leads to the occurrence of adverse events. At present, the diagnosis of UAVF mainly depends on imaging methods, among which angiography is the gold standard. Conservative treatment, interventional therapy and surgical treatment are the main treatment methods of UVAF, among which uterine artery embolization is the most commonly used, but the adverse effects of re-pregnancy are increasing year by year. According to the patient′s clinical symptoms and fertility wishes, choosing a reasonable diagnosis and treatment program can improve the prognosis and reduce the risk of re-pregnancy.

Key words: Uterus, Arteriovenous fistula, Postpartum hemorrhage, Diagnosis, Therapy

殷亚东, 刘岚. 子宫动静脉瘘引起晚期产后出血的诊疗进展[J]. 国际妇产科学杂志, 2021, 48(1): 84-88.

YIN Ya-dong, LIU Lan. Progress in Diagnosis and Treatment of Late Postpartum Hemorrhage Caused by Uterine Arteriovenous Fistula[J]. Journal of International Obstetrics and Gynecology, 2021, 48(1): 84-88.

参考文献 27

[1]	Akladios CY, Sananes N, Gaudineau A, et al. Secondary postpartum hemorrhage[J]. J Gynecol Obstet Biol Reprod (Paris), 2014,43(10):1161-1169. doi: 10.1016/j.jgyn.2014.10.008. doi: 10.1016/j.jgyn.2014.10.008
[2]	O′Brien P, Neyastani A, Buckley AR, et al. Uterine arteriovenous malformations: from diagnosis to treatment[J]. J Ultrasound Med, 2006,25(11):1387-1392. doi: 10.7863/jum.2006.25.11.1387. doi: 10.7863/jum.2006.25.11.1387 pmid: 17060424
[3]	Core JM, Carrubba AR, Paz-Fumagalli R. Rare case of a massive uterine arteriovenous fistula[J]. Am J Obstet Gynecol, 2020,222(1):85-86. doi: 10.1016/j.ajog.2019.06.003. doi: 10.1016/j.ajog.2019.06.003 pmid: 31301765
[4]	杨小凤. 剖宫产术后子宫动静脉瘘引发晚期产后出血的临床特点[J]. 中外医疗, 2011,30(22):66-67. doi: 10.3969/j.issn.1674-0742.2011.22.041.
[5]	孔慧敏, 章华. 彩色多普勒超声诊断流产后子宫动静脉瘘效果分析[J]. 中国计划生育学杂志, 2019,27(9):1243-1244,1248. doi: 10.3969/j.issn.1004-8189.2019.09.031.
[6]	Yan X, Zhao C, Tian C, et al. Ultrasound-guided high-intensity focused ultrasound ablation for treating uterine arteriovenous malformation[J]. BJOG, 2017,124(Suppl 3):93-96. doi: 10.1111/1471-0528.14749. doi: 10.1111/1471-0528.14749
[7]	Wiebe ER, Switzer P. Arteriovenous malformations of the uterus associated with medical abortion[J]. Int J Gynaecol Obstet, 2000,71(2):155-158. doi: 10.1016/s0020-7292(00)00291-5. doi: 10.1016/s0020-7292(00)00291-5 pmid: 11064013
[8]	Giurazza F, Corvino F, Paladini A, et al. Uterine Arteriovenous Fistula with Concomitant Pelvic Varicocele: Endovascular Embolization with Onyx-18?[J]. Case Rep Vasc Med, 2017,2017:3548271. doi: 10.1155/2017/3548271. doi: 10.1155/2017/3548271 pmid: 29359062
[9]	Cura M, Martinez N, Cura A, et al. Arteriovenous malformations of the uterus[J]. Acta Radiol, 2009,50(7):823-829. doi: 10.1080/02841850903008792. doi: 10.1080/02841850903008792 pmid: 19513893
[10]	Jennings L, Presley B, Krywko D. Uterine Artery Pseudoaneurysm: A Life-Threatening Cause of Vaginal Bleeding in the Emergency Department[J]. J Emerg Med, 2019,56(3):327-331. doi: 10.1016/j.jemermed.2018.12.016. doi: 10.1016/j.jemermed.2018.12.016 pmid: 30685218
[11]	Cramer SF, Heller DS. Placenta Increta Presenting as Exaggerated Placental Site Reaction[J]. Pediatr Dev Pathol, 2017,20(2):152-157. doi: 10.1177/1093526616681939. doi: 10.1177/1093526616681939 pmid: 28326953
[12]	Hong W, Wang BY, Wu ZP, et al. Systematic retrospective analysis of 13 cases of uterine arteriovenous fistula: Pathogeny, diagnosis, treatment and follow-up[J]. J Obstet Gynaecol Res, 2020,46(7):1117-1127. doi: 10.1111/jog.14264. doi: 10.1111/jog.14264 pmid: 32367675
[13]	左坤, 刘青. 获得性子宫动静脉畸形的诊治进展[J]. 中国妇幼健康研究, 2018,29(1):131-134. doi: 10.3969/j.issn.1673-5293.2018.01.036.
[14]	周莹, 王威, 梁华茂, 等. 子宫动静脉畸形的诊断和治疗进展[J]. 中国计划生育和妇产科, 2019,11(12):20-23. doi: 10.3969/j.issn.1674-4020.2019.12.08.
[15]	Kido A, Togashi K, Koyama T, et al. Retained products of conception masquerading as acquired arteriovenous malformation[J]. J Comput Assist Tomogr, 2003,27(1):88-92. doi: 10.1097/00004728-200301000-00016. doi: 10.1097/00004728-200301000-00016 pmid: 12544249
[16]	Kim TH, Kim NK, Kim SK, et al. Uterine Arteriovenous Malformation Treated by Hysteroscopic Excision[J]. Gynecol Minim Invasive Ther, 2019,8(3):132-134. doi: 10.4103/GMIT.GMIT_114_18. doi: 10.4103/GMIT.GMIT_114_18 pmid: 31544025
[17]	Degani S, Leibovitz Z, Shapiro I, et al. Expectant management of pregnancy-related high-velocity uterine arteriovenous shunt diagnosed after abortion[J]. Int J Gynaecol Obstet, 2009,106(1):46-49. doi: 10.1016/j.ijgo.2009.03.039. doi: 10.1016/j.ijgo.2009.03.039 pmid: 19375703
[18]	Timmerman D, Van den Bosch T, Peeraer K, et al. Vascular malformations in the uterus: ultrasonographic diagnosis and conservative management[J]. Eur J Obstet Gynecol Reprod Biol, 2000,92(1):171-178. doi: 10.1016/s0301-2115(00)00443-7. doi: 10.1016/s0301-2115(00)00443-7 pmid: 10986453
[19]	Ghizzoni V, Gabbrielli S, Mannini L, et al. Spontaneous Resolution of an Acquired Uterine Arteriovenous Malformation in an Elderly Primigravida[J]. Am J Case Rep, 2018,19:1140-1145. doi: 10.12659/AJCR.909635. doi: 10.12659/AJCR.909635 pmid: 30258044
[20]	Taneja A, Chopra I, Kaur H, et al. Successful management of abnormal uterine bleeding from uterine arteriovenous malformations with progesterone in postabortal patients[J]. J Obstet Gynaecol Res, 2019,45(6):1114-1117. doi: 10.1111/jog.13939. doi: 10.1111/jog.13939 pmid: 30788888
[21]	Vilos AG, Oraif A, Machado M, et al. Resolution of Uterine Arteriovenous Malformation and Maintenance of Reproduction in 20 Women Treated with a GnRH Agonist Concomitantly with an Aromatase Inhibitor and Tranexamic Acid[J]. J Obstet Gynaecol Can, 2019,41(6):772-781. doi: 10.1016/j.jogc.2018.07.018. doi: 10.1016/j.jogc.2018.07.018 pmid: 30413336
[22]	Kemal Harzif A, Rei OG, Haloho A, et al. Trans-arterial embolization of acquired uterine arteriovenous malformation after Cesarean section: A case series[J]. Int J Reprod Biomed, 2019,17(2):135-142. doi: 10.18502/ijrm.v17i2.3991.
[23]	Guan D, Wang J, Zong L, et al. Acquired uterine arteriovenous fistula due to a previous cornual pregnancy with placenta accreta: A case report[J]. Exp Ther Med, 2017,13(6):2801-2804. doi: 10.3892/etm. 017.4354. doi: 10.3892/etm.2017.4354 pmid: 28587344
[24]	Peitsidis P, Manolakos E, Tsekoura V, et al. Uterine arteriovenous malformations induced after diagnostic curettage: a systematic review[J]. Arch Gynecol Obstet, 2011,284(5):1137-1151. doi: 10.1007/s00404-011-2067-7. doi: 10.1007/s00404-011-2067-7
[25]	Evans A, Gazaille RE 3rd, McKenzie R, et al. Acquired uterine arteriovenous fistula following dilatation and curettage: an uncommon cause of vaginal bleeding[J]. Radiol Case Rep, 2017,12(2):287-291. doi: 10.1016/j.radcr.2017.01.005. doi: 10.1016/j.radcr.2017.01.005 pmid: 28491172
[26]	Guida M, Maffucci D, Iannuzzi G, et al. Successful pregnancy after uterine artery embolization for uterine arterovenous malformation: a rare case report[J]. Int J Womens Health, 2018,10:745-750. doi: 10.2147/IJWH.S182131. doi: 10.2147/IJWH.S182131 pmid: 30538584
[27]	林啸笑, 孙待飞, 傅君, 等. 子宫动脉栓塞术治疗产后出血对再次妊娠结局的影响[J]. 浙江大学学报(医学版), 2019,48(5):540-545. doi: 10.3785/j.issn.1008-9292.2019.10.12.