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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2020, Vol. 17 ›› Issue (06) : 503 -508. doi: 10.3877/cma.j.issn.1672-6448.2020.06.003

所属专题： 妇产科超声影像学； 文献； 妇产科超声；

妇产科超声影像学

子宫动静脉瘘致阴道大出血的超声图像分析
郭翠霞1, 孙丽娟1, 李菁华1, 张铁娟1, 吴青青1,†()   
  1. 1. 100026　首都医科大学附属北京妇产医院超声科
  • 收稿日期:2020-04-14 出版日期:2020-06-01
  • 通信作者: 吴青青

Ultrasonic image analysis of massive vaginal bleeding caused by uterine arteriovenous fistula

Cuixia Guo1, Lijuan Sun1, Jinghua Li1, Tiejuan Zhang1, Qingqing Wu1,†()   

  1. 1. Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
  • Received:2020-04-14 Published:2020-06-01
  • Corresponding author: Qingqing Wu
  • About author:
    Corresponding author: Wu Qingqing, Email:
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郭翠霞, 孙丽娟, 李菁华, 张铁娟, 吴青青. 子宫动静脉瘘致阴道大出血的超声图像分析[J]. 中华医学超声杂志（电子版）, 2020, 17(06): 503-508.

Cuixia Guo, Lijuan Sun, Jinghua Li, Tiejuan Zhang, Qingqing Wu. Ultrasonic image analysis of massive vaginal bleeding caused by uterine arteriovenous fistula[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(06): 503-508.

目的

探讨子宫动静脉瘘致阴道大出血患者的超声图像特点。

方法

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。

结果

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。

结论

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。

关键词: 子宫, 动静脉瘘, 超声检查, 子宫出血
Objective

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

Methods

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.

Results

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.

Conclusion

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.

Key words: Uterus, Arteriovenous fistula, Ultrasonography, Uterine hemorrhage
图1 患者，女性，28岁，孕2产1，自然分娩后30 d，阴道大量出血1 d。图a为二维超声示子宫肌层内管状无回声至低回声（细箭头所示），宫腔内非均质偏高回声（游标所示），范围约2.3 cm×1.4 cm，内见囊性区（三角箭头所示）；图b为彩色多普勒血流示子宫浆膜下延续至宫腔内的粗大单条状花色的穿肌层血流（箭头所示）；图c为频谱多普勒可引出高速低阻动脉血流频谱，RI：0.32
图2 患者，女性，29岁，孕1产0，清宫术后52 d，阴道出血加重。图a为二维超声示子宫前壁肌层回声减低不均，可见小无回声（细箭头所示），宫腔内非均质回声（粗箭头所示）；图b为彩色多普勒超声示由子宫前壁浆膜下延续至宫腔的多条状花色的穿肌层血流；图c为子宫动脉栓塞术后25 d，彩色多普勒血流示异常的穿肌层血流消失
图3 患者，女性，32岁，孕2产1，孕22周胎儿畸形引产后30 d，间断阴道出血加重。图a为灰阶超声显示宫腔内非均质回声（粗箭头所示），病变肌层无明显改变（细箭头所示）；图b为彩色多普勒血流显示由子宫前壁宫底至宫腔内的单条状花色的穿肌层血流（细箭头所示）
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