Xu Lili, Chen Haining, Xiao Yanju, Jiang Zhifeng, Zhang Jing, Jiang Yanming, Ling Dan
Department of Gynecology (Drs. Xu, Jiang, Zhang, Jiang, and Ling), The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China.
Department of Ultrasound (Drs. Chen and Xiao), The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China.
J Minim Invasive Gynecol. 2025 Jan;32(1):64-71. doi: 10.1016/j.jmig.2024.09.010. Epub 2024 Sep 12.
To evaluate the efficacy of combining high-intensity focused ultrasound (HIFU) ablation with hysteroscopic removal of retained products of conception in the presence of a uterine arteriovenous fistula (UAVF).
Prospective cohort study SETTING: Tertiary hospital.
Seventeen patients with UAVF and retained products of conception.
HIFU ablation combined with hysteroscopic removal of retained products of conception.
All patients presented with irregular vaginal bleeding following pregnancy termination and were not responsive to medical treatment. Patients were confirmed to have a UAVF along with concurrent intrauterine residue using three-dimensional color Doppler ultrasonography, uterine angiography, or pelvic-enhanced magnetic resonance imaging; and demonstrated a poor response to medical treatment. Under real-time ultrasound guidance, HIFU was used to ablate the arteriovenous malformation region. Patients underwent hysteroscopic removal of retained products of conception; the removed tissue was subjected to pathological examination. All patients underwent monthly uterine color Doppler ultrasound examinations and menstrual status follow-up within 3 months postoperatively and showed normal menstrual recovery without signs of arteriovenous malformations on ultrasonography. Pathological examination of the tissues removed during hysteroscopic clearance revealed characteristics consistent with pregnancy, with abnormal blood vessels in some tissues. All patients experienced normal menstrual recovery postoperatively, without intrauterine adhesions.
Combining HIFU ablation with postoperative hysteroscopic surgery effectively treats pregnancy-related UAVF with minimal complications and preserves fertility, it offers an additional treatment option for patients wanting future fertility.
评估高强度聚焦超声（HIFU）消融联合宫腔镜清除妊娠物残留治疗子宫动静脉瘘（UAVF）的疗效。
前瞻性队列研究
三级医院
17例患有子宫动静脉瘘及妊娠物残留的患者
HIFU消融联合宫腔镜清除妊娠物残留
所有患者均在终止妊娠后出现不规则阴道出血，且药物治疗无效。通过三维彩色多普勒超声、子宫血管造影或盆腔增强磁共振成像确诊患者存在子宫动静脉瘘及同时存在的宫内残留物；且对药物治疗反应不佳。在实时超声引导下，使用HIFU消融动静脉畸形区域。患者接受宫腔镜清除妊娠物残留；切除的组织进行病理检查。所有患者术后3个月内每月进行子宫彩色多普勒超声检查及月经状态随访，结果显示月经恢复正常，超声检查无动静脉畸形迹象。宫腔镜清宫术中切除组织的病理检查显示具有与妊娠相符的特征，部分组织存在异常血管。所有患者术后月经恢复正常，无宫腔粘连。
HIFU消融联合术后宫腔镜手术可有效治疗与妊娠相关的子宫动静脉瘘，并发症最少并保留生育能力，为希望未来生育的患者提供了一种额外的治疗选择。
