清宫后妊娠组织残留致获得性动静脉畸形1例并文献复习

Acquired Arteriovenous Malformations Caused by Residual Pregnancy Tissue after Uterine Curettage: A Case Report and Literature Review

摘要: 子宫动静脉畸形(UAVM)是子宫的动脉分支与静脉丛之间未经过毛细血管网产生的异常交通。UAVM在生殖系统出血性相关疾病中约占1%~2%。UAVM可以分为先天性和获得性两种，前者极为罕见，而获得性UAVM主要与既往病史有关，例如子宫创伤、感染、既往患子宫肿瘤等因素有关。引起子宫创伤的原因包括清宫术、剖宫产术或引起子宫创伤的盆腔手术等。临床上针对子宫动静脉畸形的治疗应结合患者的症状、病灶大小、位置、年龄、有无生育要求来制定个体化的治疗方案。我们在此报道一例清宫后妊娠组织残留致获得性动静脉畸形的病例，并对获得性UAVM的诊治进行综述。一名34岁女性患者，因清宫后异常阴道流血行妇科检查发现子宫动静脉畸形，给予米非司酮口服治疗2周效果欠佳，HCG下降缓慢，后给予患者宫腔镜检查 + 宫腔镜妊娠组织清除术 + 腹腔镜检查，定期监测HCG降至正常范围内，超声提示宫内不均质回声均消失。本例为清宫后残留妊娠组织致获得性UAVM的诊治提供新的思路。

Abstract: Uterine arteriovenous malformations (UAVM) are abnormal communications between uterine arte-rial branches and venous plexus that do not pass through the capillary network. UAVM accounts for about 1%~2% of bleeding-related diseases in the reproductive system. UAVM can be divided into congenital and acquired UAVM. The former is extremely rare, while the acquired UAVM is mainly related to past medical history, such as uterine trauma, infection, previous uterine tumors and oth-er factors. The causes of uterine trauma include curettage, cesarean section, or pelvic surgery that causes uterine trauma. The clinical treatment of uterine arteriovenous malformations should be based on the patient’s symptoms, lesion size, location, age, and fertility requirements to develop an individualized treatment plan. We report a case of acquired arteriovenous malformation caused by residual pregnancy tissue after uterine curettage, and review the diagnosis and treatment of ac-quired UAVM. A 34-year-old female patient, due to the abnormal vaginal bleeding after the uterine curettage of gynecologic examination found uterine arteriovenous malformation, giving oral mife-pristone treatment for 2 weeks but ineffective, HCG drops slowly, giving patients after hysteroscopy examination for removal of pregnancy tissue and hysteroscopy and laparoscopy, regular monitoring of HCG fell to the normal range, ultrasonic tipped intrauterine heterogeneity echoes all disappear. This case provides a new idea for the diagnosis and treatment of acquired UAVM caused by residual pregnancy tissue after uterine curettage.