摘 要
子宫动脉瘤多被认为与产程中创伤性操作相关, 但也可发生于无创伤性操作的自然分娩过程中。最近狄文和张宁等人在《浙江大学学报(英文版)B 辑: 生物医学与生物技术》中报道了一例临床病例(Zhang et al., 2017): 疤痕子宫妊娠→子宫收缩→产前出血→阴道分娩急产→严重产后出血→子宫动脉栓塞。该病例中的子宫动脉瘤形成的原因可能是: (1)此次分娩过程中, 子宫疤痕处的血管分支薄弱, 宫缩压力诱发子宫动脉瘤形成并破裂; (2)前次剖宫产术的创伤性操作导致子宫动脉瘤形成但并未破裂, 此次妊娠分娩促进动脉瘤的破裂出血。我们汇总分析了50 例子宫动脉瘤患者, 29 例都是前次妊娠(最近第2 次妊娠)有创伤性操作, 而在另外21 例中, 其中9例在最近第3 次妊娠中都存在创伤性操作。这些提示子宫动脉瘤的形成可能与所有既往的创伤性操作史有关, 两者间的时间间隔可能很长, 比如10 年甚至20 年之久。此外, 张宁等人的病例报道也提示子宫动脉瘤不仅仅表现为产后出血, 产前出血也可能是其危险信号。
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Matsubara, S., Takahashi, H., Matsubara, D. et al. Delivery or previous cesarean? A comment on “Antepartum hemorrhage from previous-cesarean-sectioned uterus as a potential sign of uterine artery pseudoaneurysm”. J. Zhejiang Univ. Sci. B 18, 723–724 (2017). https://doi.org/10.1631/jzus.B1700241
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DOI: https://doi.org/10.1631/jzus.B1700241