二维及多普勒超声在后天性子宫动静脉瘘的临床应用-东南大学学报医学版

二维及多普勒超声在后天性子宫动静脉瘘的临床应用

单位：1. 南京医科大学附属南京妇幼保健院超声科, 江苏南京 210004;
2. 南京医科大学附属南京儿童医院超声诊断科, 江苏南京 210008

分类号：R445

出版年·卷·期（页码）：2014·33·第四期（482-485）

摘要：

目的：探讨后天性子宫动静脉瘘患者的二维及多普勒超声特征并评价二维及多普勒超声在后天性子宫动静脉瘘诊断及治疗中的应用价值。方法：对既往有流产或剖宫产史并引起子宫动静脉瘘的15例患者的二维声像图、彩色多普勒及频谱多普勒超声表现进行回顾性分析，并与子宫动脉造影相对照。结果：二维超声显示，大部分患者近宫腔的肌层内出现不均匀的中低回声，内见夹管状结构；部分患者肌层内可见不均的中低回声及无回声区，病灶范围从1.2 cm×0.7 cm~3.6 cm×2.1 cm不等。彩色多普勒超声可见子宫肌层病灶区内红蓝混合、彩色混迭极丰富的血流信号，呈“湖泊样”改变。频谱多普勒可见高速低阻动静脉频谱。二维超声检查结果与子宫动脉造影结果基本一致。所有患者均接受了子宫动脉栓塞术治疗，并于术后2、4、8周复查，二维超声见病灶均有明显减小或显示不明显，与治疗前比较，差异有统计学意义（P<0.01）；彩色多普勒超声表现为低速静脉血流信号或异常血流信号消失。结论：二维及多普勒超声早期能准确诊断子宫动静脉瘘并及时帮助临床判断创伤后子宫异常出血的原因，降低患者大出血的危害，同时也是评价动静脉瘘栓塞治疗效果的最佳方法。

Objective: To study the characteristic of two-dimensional and Doppler ultrasonography in acquired uterine arteriovenous fistula patients and evaluate application value of two-dimensional and Doppler ultrasonography in diagnosis and treatment. Methods: Fifteen patients with acquired uterine arteriovenous fistula caused by uterine trauma like abortion or caesarean section underwent color Doppler sonography. Features of the two-dimensional, color Doppler, and spectral Doppler sonography were retrospectively summarized and analyzed, and were compared with uterine artery angiography. Results: The two-dimensional ultrasonography displayed uneven mid-low echo signals of uterine muscle wall near endometrium or irregular echo-free zone in the myometrium,the size of lesion ranging from 1.2 cm×0.7 cm to 3.6 cm×2.1 cm.Color Doppler ultrasound showed rich blood flow in the lesion area and lake-like or multicolored mosaic change.Spectral Doppler waveform shape was characterized as high-speed low resistance.The two-dimensional ultrasonographic results of uterine arteriovenous fistula were consistent with those of uterine artery angiography.All patients were successfully treated by uterine artery embolization. Postoperatively, they were followed up by ultrasonography at 2, 4, and 8 weeks, the lesion shrunk dramatically or even disappeared. There were significant differences between before and after treatment (P< 0.01); It was observed low-speed venous blood flow signals, and no abnormal blood flow signals on color Doppler ultrasound. Conclusions: The two-dimensional and Doppler ultrasonography could give early and accurate diagnosis of uterine arteriovenous fistula, which is helpful to find out the reasons for abnormal uterine bleeding resulted from trauma, timely reducing the harm of massive hemorrhage, as well as the best way to evaluate efficacy of arteriovenous fistula embolization.

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