Bauer V, Briex M, de Meeus J B, Drouineau J, Ferrie J C, Magnin G
Service de Gynécologie-Obstétrique, Hôpital Jean-Bernard, Poitiers.
J Gynecol Obstet Biol Reprod (Paris). 1993;22(3):312-6.
We report a case found at the start of labour because of the presence of a "tumour praevia". Ultrasound, Doppler and tomodensitometric examination carried out after caesarean section confirmed the vascular origin of this lesion. Arteriography made it possible to decide the pattern of this arteriovenous malformation which was occurring in several branches of the left internal iliac artery. It was not possible to obliterate it completely by selective arterial embolisation, so it was removed surgically a few months later. Little is known about the complications that occur because of these arteriovenous malformations in pregnancy and during delivery. There is the theoretical risk that spontaneous rupture will occur in pregnancy but this does not justify terminating the pregnancy. It is better to carry out caesarean section because the tumour can obstruct delivery and may rupture as well as causing delay in labour. The treatment for these lesions is sometimes difficult and complex and one has to decide whether to preserve the uterus or not. Selective embolisation and pre-operative embolisation followed by surgical removal of dysplasic tissue are the therapies of choice.
我们报告了一例在分娩开始时因“前置肿瘤”而被发现的病例。剖宫产术后进行的超声、多普勒和计算机断层扫描检查证实了该病变的血管起源。动脉造影能够确定这种动静脉畸形的形态，其发生于左髂内动脉的几个分支。通过选择性动脉栓塞无法将其完全闭塞，因此在几个月后进行了手术切除。关于妊娠和分娩期间因这些动静脉畸形而发生的并发症知之甚少。理论上存在妊娠期间自发破裂的风险，但这并不足以成为终止妊娠的理由。最好进行剖宫产，因为肿瘤可能会阻碍分娩，可能破裂，还可能导致产程延迟。这些病变的治疗有时困难且复杂，必须决定是否保留子宫。选择性栓塞和术前栓塞，随后手术切除发育异常组织是首选的治疗方法。
