妊娠相关子宫肌层血管增强二例

doi:10.12280/gjfckx.20251220

摘要/Abstract

摘要：

妊娠相关子宫肌层血管增强（enhanced myometrial vascularity，EMV）是一种超声表现，常见于妊娠早期胚胎停育及胚物残留等情况，其特征为子宫肌层血流信号丰富，可延伸至浆膜层，易与子宫动静脉瘘或胎盘残留混淆。报告2例妊娠相关EMV患者的临床资料。病例1清宫术后出现宫腔残留，超声示右宫角及宫腔不均质回声伴丰富血流信号，经米非司酮联合促性腺激素释放激素激动剂治疗后血流明显减弱，遂行宫腔镜下胚物去除术，术后病理证实胚物残留。病例2妊娠9周出现阴道出血，超声示子宫后壁肌层血流丰富，因症状明显及时行宫腔镜下胚物去除术及电吸刮宫术，病理证实为胚胎停育胚物组织。妊娠相关EMV的诊治应结合病史及血流动力学综合判断，避免过度干预；对一般情况稳定者可经药物干预后延迟手术，而症状明显者应及时手术，以降低风险并改善生育结局。

关键词: 子宫肌层血管增强, 胚物残留, 胚胎停育, 超声检查，多普勒, 宫腔镜检查

Abstract:

Pregnancy-associated enhanced myometrial vascularity (EMV) is a sonographic finding commonly observed in early pregnancy fetal demise or retained products of conception. It is characterized by abundant vascular signals within the myometrium that may extend to the serosal layer, and can be easily confused with uterine arteriovenous fistula or placental remnant. This article reports the clinical data of two patients with pregnancy-associated EMV. In case one, the patient presented with uterine retention following curettage. Ultrasound demonstrated heterogeneous echoes with rich blood flow signals in the right cornual and endometrial cavity. After treatment with mifepristone combined with gonadotropin-releasing hormone agonist, the blood flow was significantly reduced. Hysteroscopic removal of retained conception products was subsequently performed, And pathological examination confirmed retained products of conception. In case two, the patient experienced vaginal bleeding at 9 weeks of gestation. Ultrasound showed abundant blood flow in the posterior myometrial wall. Due to prominent symptoms, timely hysteroscopic removal of conception products and electric suction curettage were performed. Pathological findings confirmed embryonic demise with retained products. The diagnosis and management of pregnancy-associated EMV should be based on comprehensive assessment of medical history and hemodynamic status to avoid excessive intervention. For hemodynamically stable patients, delayed surgical intervention after medical therapy may be considered, whereas symptomatic patients should receive prompt surgical management to reduce risks and improve reproductive outcomes.

Key words: Enhanced myometrial vascularity, Retained products of conception, Fetal demise, Ultrasonography, Doppler, Hysteroscopy

杨雪, 马宁, 夏恩兰, 黄晓武. 妊娠相关子宫肌层血管增强二例[J]. 国际妇产科学杂志, 2026, 53(2): 184-187.

YANG Xue, MA Ning, XIA En-lan, HUANG Xiao-wu. Pregnancy-Associated Enhanced Myometrial Vascularity: Two Cases Report[J]. Journal of International Obstetrics and Gynecology, 2026, 53(2): 184-187.

图/表 1

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日期	hCG（U/L）	超声	CDFI	RI	PSV（cm/s）	治疗方案
2025年3月10日	38.77	右宫底不均质回声团，大小22 mm×25 mm×14 mm，大部分位于肌壁间，位于宫腔部分的大小11 mm×11 mm×6 mm，其内见扩张的血管，范围7 mm×5 mm	宫腔及肌壁间见五彩镶嵌血流信号	0.43	131.0	口服米非司酮
2025年3月31日	22.86	右宫底不均质回声团，大小21 mm×18 mm×14 mm，部分位于肌壁间，边界不清	肌层部分血流信号丰富，范围13 mm×12 mm	0.34	140.3	口服米非司酮
2025年4月28日	12.00	右宫角不均质回声团，大小19 mm×22 mm×18 mm，边缘贴近浆膜，部分位于宫腔呈蜂窝状，大小14 mm×7 mm×7 mm	肌层部分血流信号丰富，可测得高速血流	0.30~0.43	204.9	口服米非司酮及注射GnRH-a
2025年5月26日	5.07	右宫角不均质回声团，大小16 mm×15 mm×14 mm，边界欠清，与内膜分界欠清，局部边缘贴近浆膜	肌层部分血流信号较丰富	0.35	38.4	口服米非司酮及注射GnRH-a
2025年6月23日	2.80	右宫角及宫腔不均质回声结节，大小7 mm×7 mm×5 mm	见条形血流信号，其内见无回声，范围4 mm×4 mm×2 mm，内为低速血流	0.58	8.1	停药行宫腔镜手术治疗

日期	hCG（U/L）	超声	CDFI	RI	PSV（cm/s）	治疗方案
2025年3月10日	38.77	右宫底不均质回声团，大小22 mm×25 mm×14 mm，大部分位于肌壁间，位于宫腔部分的大小11 mm×11 mm×6 mm，其内见扩张的血管，范围7 mm×5 mm	宫腔及肌壁间见五彩镶嵌血流信号	0.43	131.0	口服米非司酮
2025年3月31日	22.86	右宫底不均质回声团，大小21 mm×18 mm×14 mm，部分位于肌壁间，边界不清	肌层部分血流信号丰富，范围13 mm×12 mm	0.34	140.3	口服米非司酮
2025年4月28日	12.00	右宫角不均质回声团，大小19 mm×22 mm×18 mm，边缘贴近浆膜，部分位于宫腔呈蜂窝状，大小14 mm×7 mm×7 mm	肌层部分血流信号丰富，可测得高速血流	0.30~0.43	204.9	口服米非司酮及注射GnRH-a
2025年5月26日	5.07	右宫角不均质回声团，大小16 mm×15 mm×14 mm，边界欠清，与内膜分界欠清，局部边缘贴近浆膜	肌层部分血流信号较丰富	0.35	38.4	口服米非司酮及注射GnRH-a
2025年6月23日	2.80	右宫角及宫腔不均质回声结节，大小7 mm×7 mm×5 mm	见条形血流信号，其内见无回声，范围4 mm×4 mm×2 mm，内为低速血流	0.58	8.1	停药行宫腔镜手术治疗