Department of Obstetrics and Gynecology, Hôpital Beaujon, AP-HP, 100 Boulevard du General Leclerc, 92110 Clichy, France.
Eur J Obstet Gynecol Reprod Biol. 2013 Oct;170(2):309-14. doi: 10.1016/j.ejogrb.2013.07.016. Epub 2013 Aug 7.
Uterine necrosis is one of the rarest complications following pelvic arterial embolization for postpartum hemorrhage (PPH). With the increasing incidence of cesarean section and abnormal placental localization (placenta previa) or placental invasion (placenta accreta/increta/percreta), more and more cases of uterine necrosis after embolization are being diagnosed and reported. Pelvic computed tomography or magnetic resonance imaging provides high diagnostic accuracy, and surgical management includes hysterectomy. We performed a Medline database query following the first description of uterine necrosis after pelvic embolization (between January 1985 and January 2013). Medical subheading search words were the following: "uterine necrosis"; "embolization"; "postpartum hemorrhage". Seventeen citations reporting at least one case of uterine necrosis after pelvic embolization for PPH were included, with a total of 19 cases. This literature review discusses the etiopathogenesis, clinical and therapeutic aspects of uterine necrosis following pelvic arterial embolization, and guidelines are detailed. The mean time interval between pelvic embolization and diagnosis of uterine necrosis was 21 days (range 9-730). The main symptoms of uterine necrosis were fever, abdominal pain, menorrhagia and leukorrhea. Surgical management included total hysterectomy (n=15, 78%) or subtotal hysterectomy (n=2, 10%) and partial cystectomy with excision of the necrotic portion in three cases of associated bladder necrosis (15%). Uterine necrosis was partial in four cases (21%). Regarding the pathophysiology, four factors may be involved in uterine necrosis: the size and nature of the embolizing agent, the presence of the anastomotic vascular system and the embolization technique itself with the use of free flow embolization.
子宫坏死是盆腔动脉栓塞治疗产后出血（PPH）后最罕见的并发症之一。随着剖宫产率的增加和胎盘位置异常（前置胎盘）或胎盘侵入（胎盘粘连/植入/穿透）的增加，越来越多的患者在栓塞后被诊断为子宫坏死。盆腔 CT 或 MRI 具有较高的诊断准确性，手术治疗包括子宫切除术。我们在首例盆腔栓塞后子宫坏死的描述（1985 年 1 月至 2013 年 1 月）后进行了 Medline 数据库查询。医学主题词搜索词为：“子宫坏死”；“栓塞”；“产后出血”。共纳入 17 篇报道至少 1 例 PPH 盆腔动脉栓塞后子宫坏死的文献，共 19 例。本文复习了盆腔动脉栓塞后子宫坏死的病因、临床和治疗方面，并详细介绍了相关指南。盆腔栓塞与子宫坏死诊断之间的平均时间间隔为 21 天（范围 9-730 天）。子宫坏死的主要症状为发热、腹痛、月经过多和白带。手术治疗包括全子宫切除术（n=15，78%）或次全子宫切除术（n=2，10%），三例合并膀胱坏死的患者行部分子宫切除术和膀胱部分切除术切除坏死部分（15%）。四例（21%）患者的子宫坏死为部分性。关于发病机制，可能有四个因素参与子宫坏死：栓塞剂的大小和性质、吻合血管系统的存在以及栓塞技术本身，包括自由流动栓塞。
