High-Intensity Focused Ultrasound Ablation Combined With Hysteroscopy for the Treatment of Uterine Arteriovenous Fistula Associated With Retained Products of Conception: A Prospective Cohort Study.
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引用次数: 0
Abstract
Study objective: 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).
Design: Prospective cohort study SETTING: Tertiary hospital.
Patients: Seventeen patients with UAVF and retained products of conception.
Interventions: HIFU ablation combined with hysteroscopic removal of retained products of conception.
Measurements and main results: 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.
Conclusion: 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.
期刊介绍：
The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.
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