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目的研究子宫动脉栓塞术(UAE)治疗获得性子宫动静脉瘘的临床效果。方法回顾性总结2011年6月-2016年5月入该院首次诊断为获得性子宫动静脉瘘患者32例,均经彩色多普勒超声和血管造影确诊,接受选择性双侧UAE治疗,随访中位时间12.0个月,分析治疗效果。结果 32例患者中子宫大小正常14例(43.75%),其余患者子宫增大;子宫后壁18例,前壁10例,子宫角4例;病灶为非均质改变,网格状回声,最大直径约3.5~8.0 cm,平均(5.5±2.6)cm,边界较清晰;血流信号丰富,呈“五彩镶嵌状”;频谱为高速低阻型,收缩期峰值速度(PSV)平均为(54.5±11.2)cm/s,阻力指数(RI)平均为(0.37±0.04)。32例患者中共有6例(18.75%)患者再次出现阴道流血,无效组治疗后的PSV和RI值高于有效组,差异具有统计学意义(P<0.05)。复发时间3~11个月,平均复发时间为(8.6±3.5)个月。两组患者均未出现严重术后并发症。结论彩色多普勒超声诊断获得性子宫动静脉瘘有特征性表现,UAE治疗安全、有效,术后PSV和RI值可作为预测再次复发的重要指标。
Objective To study the clinical efficacy of uterine arterial embolization (UAE) in the treatment of acquired uterine arteriovenous fistula. Methods From June 2011 to May 2016, 32 patients with acquired uterine arteriovenous fistula who were admitted to our hospital for the first time were retrospectively reviewed. All patients were confirmed by color Doppler ultrasound and angiography. The patients were followed up for selective bilateral UAE. The median time of 12.0 months, analysis of treatment. Results In 32 cases, the size of the uterus was normal in 14 cases (43.75%). The rest of the uterus was enlarged. The posterior wall of the uterus was enlarged in 18 cases, the anterior wall in 10 cases and the uterine horn in 4 cases. The lesions were heterogeneous, The diameter was about 3.5 ~ 8.0 cm with an average of (5.5 ± 2.6) cm, and the border was clearer. The blood flow signal was rich and showed “multicolored mosaic”. The spectrum was high speed and low resistance. The mean systolic peak velocity (PSV) 54.5 ± 11.2) cm / s, and the average resistance index (RI) was (0.37 ± 0.04). Vaginal bleeding occurred again in 6 of 32 patients (18.75%). The PSV and RI of invalid group were higher than that of effective group (P <0.05). The recurrence time was 3 to 11 months, and the average recurrence time was (8.6 ± 3.5) months. No serious postoperative complications occurred in either group. Conclusion The color Doppler ultrasound diagnosis of acquired uterine arteriovenous fistula has the characteristic manifestation. UAE treatment is safe and effective. Postoperative PSV and RI values can be used as an important index to predict recurrence.