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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。
Uterine aneurysms are mostly thought to be associated with traumatic procedures in the labor process, but can also occur during spontaneous labor without traumatic procedures. Recently, Dewen and Zhang Ning et al reported a case of clinical disease in Journal of Zhejiang University (Series B: Biomedical and Biotechnology) (Zhang et al., 2017): Scar uterine pregnancy → uterine contractions → prenatal Bleeding → vaginal delivery emergency → severe postpartum hemorrhage → uterine artery embolism. The reasons for the formation of uterine aneurysms in this case may be: (1) during this delivery, the blood vessel branches at the uterine scar are weak and uterine contractions pressure induces the formation and rupture of the uterine aneurysm; (2) the previous cesarean section The traumatic operation led to the formation of uterine aneurysms but did not rupture, the pregnancy to promote aneurysm rupture bleeding. We analyzed a total of 50 patients with uterine aneurysms, 29 of whom had traumatic procedures in the previous pregnancy (the last 2nd pregnancy), while in the other 21 cases, 9 of them had trauma in the third of the last pregnancies Sexual manipulation. These suggest that the formation of uterine aneurysms may be related to the history of all previous traumatic procedures, the time between the two may be very long, such as 10 years or even 20 years. In addition, Zhang Ning et al case reports also suggest that uterine aneurysms not only showed postpartum hemorrhage, prenatal bleeding may also be the danger signal.