探讨子宫动静脉瘘致阴道大出血患者的超声图像特点。

收集2015年1月至2018年12月于首都医科大学附属北京妇产医院因阴道大量出血住院治疗，经盆腔动脉造影证实为子宫动静脉瘘的20例患者的超声图像和临床资料，并对其进行分析和总结。

子宫动静脉瘘致阴道大量出血患者共20例，其中9例为自然分娩后，4例为中期引产术后，4例为人工流产术后，2例为药物流产后，1例为自然流产后。灰阶超声：20例患者均表现为宫腔内非均质回声，范围约1.7 cm×1.3 cm×0.6 cm至5.3 cm×5.8 cm×3.1 cm，其中8例患者宫腔内可见囊性区，内透声差，呈涌动状；8例患者病变肌层呈低或无回声改变，10例仅表现为肌层回声不均，2例患者肌层无明显改变。彩色多谱勒超声：10例患者表现为粗大的单条状花色血流，10例患者表现为多条状的花色血流，血流走向均显示为穿肌层血流，由子宫浆膜下肌层延续至宫腔内。频谱多普勒：20例患者均可引出低阻力动脉血流频谱，阻力指数（RI）平均值0.34（0.19~0.48），搏动指数（PI）平均值0.47（0.29~0.65），峰值流速（PSV）变异较大，平均值54.3（11.8~117.3）cm/s。

子宫动静脉瘘致阴道大量出血患者宫腔内均可见非均质回声，灰阶超声显示病变肌层无特异性，可为肌层回声不均匀、无回声或低回声，甚至无明显改变；彩色多普勒具有特征性，表现为粗大的单条状或多条状五彩镶嵌的穿肌层血流，由浆膜下肌层延续至宫腔内；频谱多普勒可引出低阻力动脉血流频谱，峰值流速PSV变异较大。

To explore the ultrasonic characteristics of massive vaginal bleeding caused by uterine arteriovenous fistula.

Ultrasound images and clinical data of 20 patients admitted to Beijing Obstetrics and Gynecology Hospital, Capital Medical University for massive vaginal bleeding from January 2015 to December 2018 were collected, analyzed, and summarized. All patients were confirmed by arteriography as having uterine arteriovenous fistula.

There were a total of 20 cases of massive vaginal bleeding caused by uterine arteriovenous fistula, including 9 after natural delivery, 4 after mid-term labor induction, 4 after induced abortion, 2 after drug abortion, and 1 after spontaneous abortion. Grayscale ultrasonography showed that all the 20 patients presented with intrauterine heterogeneous echo, ranging from 1.7 cm×1.3 cm×0.6 cm to 5.3 cm×5.8 cm×3.1 cm, of whom 8 had cystic areas with whirling echo in the intrauterine cavity, 8 showed hypoechoic changes in the lesioned myometrium, 10 showed only heteroechoic changes, and 2 showed no obvious changes in the myometrium. Color Doppler flow imaging showed that 10 patients presented with thick single-striped color blood flow, and 10 patients presented with multi-striped color blood flow. The blood flow trend was all shown as passing through the myometrium, which extended from the subserosal myometrium to the uterine cavity. Pulsed wave Doppler showed that all the 20 patients presented with the arterial blood flow spectrum with low resistance; the mean resistance index (RI) was 0.34 (0.19-0.48), mean pulse index (PI) was 0.47 (0.29-0.65), and peak systolic velocity (PSV) varied between 11.8-117.3 (mean, 54.3) cm/s.

Heterogeneous echoes are present in the uterine cavity in all patients with massive vaginal bleeding caused by uterine arteriovenous fistula. On gray scale ultrasound, the myometrium of the lesion has no specific manifestations, and the myometrium echo could be heterogeneous, anechoic, or hypoechoic, even without obvious changes. On color Doppler, it is characterized by thick single-striped or multi-striped flow throughout the myometrium extending from the subserosal myometrium to the uterine cavity. On spectrum Doppler, the resistance of arterial blood flow is low and PSV varies considerably.