Clinical Analysis Of 13 Cases Of Uterine Arteriovenous Fistula

Objective:The purpose of this study was to analyze the clinical features pathogenesis,diagnosis and treatment of uterine arteriovenous fistula.Methods:Retrospective analysis was performed on 13 cases of uterine arteriovenous fistula patients admitted to the first affiliated hospital of Kunming medical university friom January 2010 to November 2019,and their clinical data and follow-up results were analyzed and summarized.The follow-up methods were telephone and outpatient.Results:All the patients were women of childbearing age,aged 21-39 years old,with an average age of 31.08±4.99 years old.All the patients had a history of uterine cavity operation,6 had a history of Cesarean section.7 had a hiatory of natural delivery,including 1 case of trophoblast cell tumor and 2 cases of Cesarean section pregnancy.5 of the 13 patients presented with sudden massive vaginal bleeding without obvious cause.In 1 case,there was intermittent vaginal bleeding with a small amout at the beginning and gradually increased until hemorrhagic shock.One case presented a large number of vaginal bleeding immediately after abortion.One case had lochia cleanness 20 days after natural labor,and vaginal bleeding occurred more than 10 days later.5 cases of abnormal menstruation:the symptoms were prolonged menstrual period,more menstrual volume,accompanied by lower abdominal pain,lunbar acid distension.All the patients were initially diagnosed by color Doppler,1 patient was further diagnosed by pelvic MRA,and 12 patients were diagnose by DSA.Conservative treatment in 1 case;2 Complete open hysterectomy+bilateral salpinggectomy;UAE+open hysterectomy+repair was performed.Perform UAE.three of the 13 patients relapsed.6 cases of menstruation and pregnancy after UAE without hysterectomy were collected.Conclusion:1、Uterine trauma history is a high risk factor for acquired uterine arteriovenous fistula.Sudden vaginal bleeding was the main clinical symptom.2、Transvaginal color Doppler ultrasound is the preferred method for diagnosis,screening and follow-up.CT and MRI can understand the pelvic anatomical relationship of the lesion.Digtal subtraction angiography is the gold standard for diagnosing uterine arteriovenous fistula.3、In the treatment of this disease,the patient’s age,symptoms,fertility needs,personal will and economic situation should be taken into account.Patients with mild,asymptomatic symptoms and adequate follow-up conditions can be combined with observation,regular follow-up and drug treatment;Uterine arterial embolization is the preferred treatment for patients with severe symptoms,fertility needs or failure of conservative treatment,with a high cure rate and a good prognosis.If the patient has severe symptoms andno fertility needs,the can choose total hysterectomy to achieve the effect of radical treatment.UAE+scarfocus resection can be used in patients with scar pregnancy complicated with uterine arteriovenous fistula,which is safer and more thorogh.