本文選題：子宮 + 盆腔��； 參考：《山東大學(xué)》2014年碩士論文

【摘要】：目的子宮及盆腔動(dòng)靜脈畸形(arteriovenous malformations, AVMs)是指子宮及盆腔動(dòng)脈與靜脈之問(wèn)通過(guò)微瘺、中瘺、大瘺直接相通,高壓動(dòng)脈血液跨過(guò)毛細(xì)血管網(wǎng)直接分流入低阻力的靜脈,在婦科疾病中屬臨床罕見(jiàn),間斷性陰道大量出血是其最主要的癥狀。以往由于發(fā)生率很低、實(shí)踐經(jīng)驗(yàn)少,對(duì)該疾病的診治認(rèn)識(shí)不足,常常因誤診為功血或妊娠物殘留等,給予刮宮治療時(shí)引發(fā)子宮大量出血,嚴(yán)重者可導(dǎo)致失血性休克甚至對(duì)生命造成威脅。近幾年發(fā)病率稍有上升,除與醫(yī)生對(duì)子宮動(dòng)靜脈畸形疾病的認(rèn)識(shí)的增加、診斷技術(shù)進(jìn)步使診斷率提高有關(guān)外,其發(fā)病因素也越來(lái)越受到人們的關(guān)注。本研究旨在通過(guò)對(duì)近6年來(lái)收治的12例子宮及盆腔動(dòng)靜脈畸形的病例進(jìn)行分析,總結(jié)其在發(fā)病因素、臨床特點(diǎn)、診斷方法及治療措施等方面的共性及相關(guān)性,探討該病在預(yù)防和治療方面的合理方法。 方法對(duì)2007年4月至2013年1月期間在山東大學(xué)齊魯醫(yī)院診治的12例子宮及盆腔動(dòng)靜脈畸形患者的臨床資料進(jìn)行回顧性分析,內(nèi)容包括：患者的發(fā)病年齡、孕產(chǎn)次、創(chuàng)傷手術(shù)史、臨床表現(xiàn)、診斷及治療的經(jīng)過(guò)及效果。 結(jié)果12例患者的發(fā)病年齡為23—57歲,中位年齡31歲,均有子宮創(chuàng)傷史(包括剖宮產(chǎn)手術(shù)、流產(chǎn)或刮宮術(shù)、分娩、子宮肌瘤剝除術(shù)等),有一次子宮創(chuàng)傷史1例,多次(=2次)子宮創(chuàng)傷史11例。10例以不規(guī)則陰道流血為主要癥狀,1例主要表現(xiàn)為月經(jīng)量增多、經(jīng)期延長(zhǎng),1例以大腿內(nèi)側(cè)疼痛為主要臨床表現(xiàn)。12例患者均先予彩色多普勒超聲篩查,9例進(jìn)一步經(jīng)盆腔CT、CTA或MRI檢查確診；6例經(jīng)動(dòng)脈血管造影確診；7例有組織病理學(xué)結(jié)果得以證實(shí)。子宮動(dòng)脈栓塞(UAE)治療6例,其中2例好轉(zhuǎn),3例轉(zhuǎn)為手術(shù)治療,1例1年后復(fù)發(fā)；手術(shù)治療成功7例,1例失訪；藥物保守治療好轉(zhuǎn)1例。 結(jié)論1.育齡女性為好發(fā)人群,多次子宮手術(shù)創(chuàng)傷史是重要的誘發(fā)因素。 2.不規(guī)則陰道流血為最主要的臨床癥狀,故在陰道出血的病因分析時(shí)應(yīng)提高警惕。 3.本病的診斷應(yīng)在考慮誘因、癥狀的基礎(chǔ)上,結(jié)合多種輔助檢查方法。彩色多普勒超聲檢查應(yīng)列為子宮動(dòng)靜脈畸形首選的篩查、診斷以及隨訪手段。盆腔CTA或MRI檢查可了解病變范圍及與周圍血管的關(guān)系,術(shù)前不可或缺。盆腔血管造影仍為子宮及盆腔動(dòng)靜脈畸形診斷的“金標(biāo)準(zhǔn)”。 4.本病的治療應(yīng)綜合考慮患者的癥狀、病變范圍、年齡、有無(wú)生育要求、有無(wú)系統(tǒng)疾病等因素決定。確診早、無(wú)陰道流血癥狀或癥狀輕微者,可試行藥物等保守治療；高選擇性子宮動(dòng)脈栓塞術(shù)具有保存子宮和卵巢功能等優(yōu)點(diǎn),但因達(dá)不到根治目的、癥狀易復(fù)發(fā),僅作為病變局限于子宮、年輕并要求保留生育功能患者的首選治療方法；完整的病灶及子宮切除術(shù)是最確切、最徹底的治療方案,尤其適用于年齡大、無(wú)生育要求的、癥狀重、隨訪條件差、藥物治療或栓塞失敗的子宮或盆腔動(dòng)靜脈畸形患者。
[Abstract]:Objective uterine and pelvic arteriovenous malformation (arteriovenous malformations, AVMs) refers to the direct communication between uterine and pelvic arteries and veins through microfistula, middle fistula and large fistula, and blood flow from high pressure artery across capillary network directly into the vein with low resistance. It is rare in gynecological diseases, intermittent vaginal bleeding is the main symptom. In the past, because of the low incidence rate and little practical experience, the diagnosis and treatment of the disease was not well understood, and the uterine bleeding was often caused by the misdiagnosis of the disease, such as blood from work or the residue of pregnancy, and so on, when given curettage treatment. Severe cases can lead to hemorrhagic shock or even life-threatening. In recent years, the incidence rate has slightly increased. Besides the increase of doctors' understanding of uterine arteriovenous malformation and the improvement of diagnostic technology, the diagnosis rate has been improved, and the pathogenesis of the disease has been paid more and more attention. The purpose of this study was to analyze 12 cases of Arteriovenous malformation (AVM) of uterus and pelvic cavity in the past 6 years, and to summarize the commonness and relativity of the disease factors, clinical characteristics, diagnostic methods and treatment measures. To explore the reasonable methods of prevention and treatment of the disease. Methods the clinical data of 12 patients with Arteriovenous malformation (AVM) of uterus and pelvic cavity in Qilu Hospital of Shandong University from April 2007 to January 2013 were retrospectively analyzed. Clinical manifestations, diagnosis and treatment of the course and effect. Results the onset age of 12 patients was 23-57 years old, with a median age of 31 years. All of them had a history of uterine trauma (including cesarean section, abortion or curettage, delivery, myomectomy, etc.), and one case had a history of uterine trauma. There were 11 cases (10 cases) with irregular vaginal bleeding as the main symptom in 11 cases with multiple (2 times) uterine trauma, 1 case with increased menstrual volume, 1 case with irregular vaginal bleeding as the main symptom. One patient with medial thigh pain as the main clinical manifestation. All the 12 patients were screened by color Doppler ultrasound in 9 cases and confirmed by CTA or MRI in the pelvic cavity. 6 cases were diagnosed by arteriography. Histopathological findings were confirmed in 7 cases. Uterine artery embolism (UAE) was treated in 6 cases, of which 2 cases improved and 3 cases changed to surgical treatment, 1 case recurred after one year, 7 cases lost visit after operation, and 1 case got better after conservative drug therapy. Conclusion 1. Women of childbearing age are predilection population. The history of multiple uterine surgery trauma is an important factor. 2. 2. Irregular vaginal bleeding is the main clinical symptom. The diagnosis of this disease should be based on the consideration of inducement and symptoms, combined with a variety of auxiliary examination methods. Color Doppler ultrasonography should be the first choice for screening, diagnosis and follow-up of uterine arteriovenous malformations. Pelvic CTA or MRI can understand the extent of lesions and the relationship with peripheral blood vessels. Pelvic angiography is still the gold standard for the diagnosis of uterine and pelvic arteriovenous malformations. The treatment of this disease should take into account the symptoms, lesion range, age, fertility requirements, whether there are systemic diseases and other factors. For those with early diagnosis and no symptoms of vaginal bleeding or mild symptoms, conservative treatment such as drugs can be tried. High selective uterine artery embolization has the advantages of preserving the function of uterus and ovary, but it is easy to recur due to the failure to achieve radical cure. Only limited to the uterus as a disease, young and requiring the preservation of fertility function of the first choice of treatment; complete lesions and hysterectomy is the most accurate, the most thorough treatment, especially for older, childless, severe symptoms, Patients with uterine or pelvic arteriovenous malformations with poor follow-up, failed drug therapy or embolization.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R711.1

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳勝利;黃子誠(chéng);陳國(guó)東;田f^;;動(dòng)脈栓塞治療男性先天性盆腔動(dòng)靜脈畸形一例[J];介入放射學(xué)雜志;2008年05期

2 ;[J];;年期

3 ;[J];;年期

4 ;[J];;年期

5 ;[J];;年期

6 ;[J];;年期

7 ;[J];;年期

8 ;[J];;年期

9 ;[J];;年期

10 ;[J];;年期

相關(guān)碩士學(xué)位論文 前1條

1 徐青;子宮及盆腔動(dòng)靜脈畸形12例臨床分析[D];山東大學(xué);2014年

，

本文編號(hào)：2104210