【摘要】 目的探讨剖宫产术后子宫切口憩室反复阴道出血的介入诊疗作用。方法回顾我院1例剖宫产术后子宫切口憩室反复出血的盆腔动脉DSA表现及栓塞治疗,并结合文献复习该病发病原因、影像学表现及治疗方法。结果患者因阴道反复出血前后共经历3次盆腔动脉DSA造影及栓塞治疗,短期止血效果肯定。DSA表现为子宫动脉、阴部内动脉参与供血,供血动脉均增粗、扭曲,右侧子宫弓状动脉增粗,左侧子宫末梢动脉可见对比剂外溢征象,未见明显肿瘤染色或动静脉瘘征象。最后经宫腔镜证实子宫切口瘢痕内多发小憩室形成,其内可见积血。后经开腹手术切除子宫切口瘢痕组织,随访1年未见出血复发。结论子宫切口憩室DSA造影表现不具特征性,介入栓塞治疗协同2期外科根治术疗效肯定。更多还原

【Abstract】 Objective To evaluate the interventional embolization therapy in treating uterine incisional diverticula(i.e. previous cesarean scar defect) due to previous cesarean section associated with recurrent vaginal massive hemorrhage and to discuss DSA findings of previous cesarean scar defect. Methods The clinical data of one patient with uterine incisional diverticula due to previous cesarean section complicated by recurrent vaginal massive hemorrhage were reviewed. The DSA findings and the results of interventional embolization therapy were analyzed. Combined with the medical literature, the mechanism of the disease, imaging manifestations and the treatment were discussed. Results As repeated vaginal massive hemorrhage the patient underwent 3 times of pelvic artery angiography and embolization therapy, and clinically satisfactory short- term hemostatic effect was achieved. DSA demonstrated that both uterine artery and internal pubic artery participated in the blood supply of the lesions. The feeding arteries were thickened and tortuous, the right uterine arcuate artery was wider, and the contrast extravasation sign was seen at the left uterine peripheral arteries. No obvious tumor staining or arteriovenous fistula was detected. Hysteroscopic examination revealed that multiple tiny diverticula with hematocele developed within the cesarean scar. The uterine incisional scar was surgically removed through laparotomy. During one year follow- up no recurrence of bleeding was observed. Conclusion Uterine incisional diverticula have no characteristic DSA manifestations, and interventional embolization therapy with subsequent radical surgery has definite therapeutic effect.更多还原