Ros Cristina, Barnes Daniel, Fervienza Anna, Oses Gabriella, Alcázar Juan L, Martínez-Román Sergio, Rovirosa Àngels, Carmona Francisco, Gómez Fernando
1 ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
2 Department of Radiology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
Br J Radiol. 2017 Jun;90(1074):20160913. doi: 10.1259/bjr.20160913. Epub 2017 May 25.
To evaluate the utility of transvaginal ultrasound-guided thrombin injection (UGTI) to treat uterine artery pseudoaneurysms (UAPs) as an alternative to emergency arterial embolization.
Two females presenting with heavy vaginal bleeding were diagnosed with UAPs by pelvic CT scan. After UAP identification by transvaginal ultrasound, 2 cm of thrombin (Tissucol; Baxter Healthcare Corporation, Munich, Germany) was slowly injected into the UAPs using a 30-cm long 22-gauge needle through a needle guide attached to the vaginal probe. The same procedure was performed in both cases, and the Doppler sign disappeared immediately and the bleeding stopped.
We describe two cases of UAPs treated with transvaginal UGTI: one after intrauterine tandem and vaginal colpostat insertion for brachytherapy after diagnosis of cervical cancer (Case 1) and the other after the insertion of a levonorgestrel-releasing intrauterine device (Case 2).
Transvaginal UGTI could be a minimally invasive tool to treat selected cases of UAPs with severe vaginal bleeding. Advances in knowledge: Transvaginal UGTI could avoid the need for uterine embolization and emergency hysterectomy in selected cases of UAPs diagnosed by CT scan.
评估经阴道超声引导下注射凝血酶（UGTI）治疗子宫动脉假性动脉瘤（UAPs）作为紧急动脉栓塞替代方法的效用。
两名出现严重阴道出血的女性通过盆腔CT扫描被诊断为UAPs。经阴道超声识别UAPs后，使用一根30厘米长的22号针头，通过连接在阴道探头的针引导器，将2厘米的凝血酶（Tissucol；德国慕尼黑百特医疗保健公司）缓慢注入UAPs。两例均采用相同操作，多普勒信号立即消失且出血停止。
我们描述了两例经阴道UGTI治疗的UAPs病例：一例是在诊断为宫颈癌后进行子宫内串联和阴道后装治疗时发生（病例1），另一例是在插入左炔诺孕酮宫内节育器后发生（病例2）。
经阴道UGTI可能是治疗某些伴有严重阴道出血的UAPs病例的微创工具。知识进展：经阴道UGTI可避免对CT扫描诊断出的某些UAPs病例进行子宫栓塞和紧急子宫切除术。
