子宫及盆腔动静脉畸形12例临床分析

发布时间：2018-07-07 07:15

本文选题：子宫 + 盆腔　；参考：《山东大学》2014年硕士论文

【摘要】：目的子宫及盆腔动静脉畸形(arteriovenous malformations, AVMs)是指子宫及盆腔动脉与静脉之问通过微瘘、中瘘、大瘘直接相通,高压动脉血液跨过毛细血管网直接分流入低阻力的静脉,在妇科疾病中属临床罕见,间断性阴道大量出血是其最主要的症状。以往由于发生率很低、实践经验少,对该疾病的诊治认识不足,常常因误诊为功血或妊娠物残留等,给予刮宫治疗时引发子宫大量出血,严重者可导致失血性休克甚至对生命造成威胁。近几年发病率稍有上升,除与医生对子宫动静脉畸形疾病的认识的增加、诊断技术进步使诊断率提高有关外,其发病因素也越来越受到人们的关注。本研究旨在通过对近6年来收治的12例子宫及盆腔动静脉畸形的病例进行分析,总结其在发病因素、临床特点、诊断方法及治疗措施等方面的共性及相关性,探讨该病在预防和治疗方面的合理方法。方法对2007年4月至2013年1月期间在山东大学齐鲁医院诊治的12例子宫及盆腔动静脉畸形患者的临床资料进行回顾性分析,内容包括：患者的发病年龄、孕产次、创伤手术史、临床表现、诊断及治疗的经过及效果。结果12例患者的发病年龄为23—57岁,中位年龄31岁,均有子宫创伤史(包括剖宫产手术、流产或刮宫术、分娩、子宫肌瘤剥除术等),有一次子宫创伤史1例,多次(=2次)子宫创伤史11例。10例以不规则阴道流血为主要症状,1例主要表现为月经量增多、经期延长,1例以大腿内侧疼痛为主要临床表现。12例患者均先予彩色多普勒超声筛查,9例进一步经盆腔CT、CTA或MRI检查确诊；6例经动脉血管造影确诊；7例有组织病理学结果得以证实。子宫动脉栓塞(UAE)治疗6例,其中2例好转,3例转为手术治疗,1例1年后复发；手术治疗成功7例,1例失访；药物保守治疗好转1例。结论1.育龄女性为好发人群,多次子宫手术创伤史是重要的诱发因素。 2.不规则阴道流血为最主要的临床症状,故在阴道出血的病因分析时应提高警惕。 3.本病的诊断应在考虑诱因、症状的基础上,结合多种辅助检查方法。彩色多普勒超声检查应列为子宫动静脉畸形首选的筛查、诊断以及随访手段。盆腔CTA或MRI检查可了解病变范围及与周围血管的关系,术前不可或缺。盆腔血管造影仍为子宫及盆腔动静脉畸形诊断的“金标准”。 4.本病的治疗应综合考虑患者的症状、病变范围、年龄、有无生育要求、有无系统疾病等因素决定。确诊早、无阴道流血症状或症状轻微者,可试行药物等保守治疗；高选择性子宫动脉栓塞术具有保存子宫和卵巢功能等优点,但因达不到根治目的、症状易复发,仅作为病变局限于子宫、年轻并要求保留生育功能患者的首选治疗方法；完整的病灶及子宫切除术是最确切、最彻底的治疗方案,尤其适用于年龄大、无生育要求的、症状重、随访条件差、药物治疗或栓塞失败的子宫或盆腔动静脉畸形患者。
[Abstract]:Objective uterine and pelvic arteriovenous malformation (arteriovenous malformations, AVMs) refers to the direct communication between uterine and pelvic arteries and veins through microfistula, middle fistula and large fistula, and blood flow from high pressure artery across capillary network directly into the vein with low resistance. It is rare in gynecological diseases, intermittent vaginal bleeding is the main symptom. In the past, because of the low incidence rate and little practical experience, the diagnosis and treatment of the disease was not well understood, and the uterine bleeding was often caused by the misdiagnosis of the disease, such as blood from work or the residue of pregnancy, and so on, when given curettage treatment. Severe cases can lead to hemorrhagic shock or even life-threatening. In recent years, the incidence rate has slightly increased. Besides the increase of doctors' understanding of uterine arteriovenous malformation and the improvement of diagnostic technology, the diagnosis rate has been improved, and the pathogenesis of the disease has been paid more and more attention. The purpose of this study was to analyze 12 cases of Arteriovenous malformation (AVM) of uterus and pelvic cavity in the past 6 years, and to summarize the commonness and relativity of the disease factors, clinical characteristics, diagnostic methods and treatment measures. To explore the reasonable methods of prevention and treatment of the disease. Methods the clinical data of 12 patients with Arteriovenous malformation (AVM) of uterus and pelvic cavity in Qilu Hospital of Shandong University from April 2007 to January 2013 were retrospectively analyzed. Clinical manifestations, diagnosis and treatment of the course and effect. Results the onset age of 12 patients was 23-57 years old, with a median age of 31 years. All of them had a history of uterine trauma (including cesarean section, abortion or curettage, delivery, myomectomy, etc.), and one case had a history of uterine trauma. There were 11 cases (10 cases) with irregular vaginal bleeding as the main symptom in 11 cases with multiple (2 times) uterine trauma, 1 case with increased menstrual volume, 1 case with irregular vaginal bleeding as the main symptom. One patient with medial thigh pain as the main clinical manifestation. All the 12 patients were screened by color Doppler ultrasound in 9 cases and confirmed by CTA or MRI in the pelvic cavity. 6 cases were diagnosed by arteriography. Histopathological findings were confirmed in 7 cases. Uterine artery embolism (UAE) was treated in 6 cases, of which 2 cases improved and 3 cases changed to surgical treatment, 1 case recurred after one year, 7 cases lost visit after operation, and 1 case got better after conservative drug therapy. Conclusion 1. Women of childbearing age are predilection population. The history of multiple uterine surgery trauma is an important factor. 2. 2. Irregular vaginal bleeding is the main clinical symptom. The diagnosis of this disease should be based on the consideration of inducement and symptoms, combined with a variety of auxiliary examination methods. Color Doppler ultrasonography should be the first choice for screening, diagnosis and follow-up of uterine arteriovenous malformations. Pelvic CTA or MRI can understand the extent of lesions and the relationship with peripheral blood vessels. Pelvic angiography is still the gold standard for the diagnosis of uterine and pelvic arteriovenous malformations. The treatment of this disease should take into account the symptoms, lesion range, age, fertility requirements, whether there are systemic diseases and other factors. For those with early diagnosis and no symptoms of vaginal bleeding or mild symptoms, conservative treatment such as drugs can be tried. High selective uterine artery embolization has the advantages of preserving the function of uterus and ovary, but it is easy to recur due to the failure to achieve radical cure. Only limited to the uterus as a disease, young and requiring the preservation of fertility function of the first choice of treatment; complete lesions and hysterectomy is the most accurate, the most thorough treatment, especially for older, childless, severe symptoms, Patients with uterine or pelvic arteriovenous malformations with poor follow-up, failed drug therapy or embolization.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.1

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