子宫肌瘤的血供分型及其对栓塞治疗的指导意义  

Angiographic classification of uterine fibroids and its significance to therapeutic embolization strategy

作　　者：王杰[1] 张国英[2] 杨乃明[2] 施海彬[1] 冯耀良[1] 王卫东[1] 王永利[1] 刘圣[1] 刘嘉茵[2] 

机构地区：[1]南京医科大学第-附属医院江苏省人民医院放射科,210029 [2]南京医科大学第-附属医院江苏省人民医院妇产科,210029

出　　处：《介入放射学杂志》2006年第5期274-277,共4页Journal of Interventional Radiology

摘　　要：目的分析子宫肌瘤的血供特征并提出血管造影分型、探讨血供分型对于栓塞的指导意义。方法50例资料完整、血管造影显示清晰的子宫肌瘤病例,采用Dextran微球子宫动脉栓塞。栓塞前,先作双侧选择性的髂内和子宫动脉血管造影,分析血管造影图像以确定双侧子宫动脉对子宫和子宫肌瘤的血供、血供比例、子宫动脉的跨中线吻合和卵巢实质显影等情况。结果按照双侧子宫动脉对子宫肌瘤的不同供血比例可将之分为3型:单侧供血型、一侧优势型和双侧均势型。50例中,这3型的比例分别为6%(3例,1例右侧,2例左侧)、84%(42例,左右侧优势各21例)和10%(5例)。双侧子宫动脉间存在明显吻合者5例、发现副子宫动脉者2例。有15例可见子宫动脉的卵巢支显影及卵巢实质染色,而通过卵巢血管吻合逆行显示同侧卵巢动脉者为5例,占10%。结论应倡导个体化的子宫肌瘤动脉栓塞策略。根据两侧子宫动脉对子宫肌瘤的不同供血比例合理分配微球栓塞剂。当造影看到卵巢动脉显影时,则宜选择直径大于350μm的微球作子宫动脉栓塞,以保护卵巢功能。Objective To analyze the vascular manifestations of uterine myomata, to offer a proposal for the angiographic classification of fibroids, and to discuss its practical significance to the strategy of uterine artery embolization. Methods Fifty patients with fibroids were performed uterine artery embolization with dextran microspheres. After bilateral hypogastric and uterine arteriography, the angiographic manifestations were studied to determine the bilateral uterine arterial blood supply and the feeding proportions to the uterus and myomata respectively. The cross median line anastomoses of bilateral uterine arteries and ovarian parenchymal opacification were also evaluated. Results According to the different feeding proportions to the uterine leiomyomata by bilateral uterine arteries,the fibroids could be divided into three types： unilateral, predominantly unilateral, and evenly bilateral supplying type. The constitution ratios of these three types were 6%, 84%, and 10% in 50 patients, of which the predominantly unilateral type was the majority occupying 84%. The obvious anastomoses between the bilateral uterine arteries were found in 5, and accessory uterine artery in 2 cases. In addition, the ovarian branches of uterine artery and ovarian opacification were revealed in 15 patients, of which the ipsilateral ovarian artery was retrogradely filled through ovarian anastomoses in 5 （10%）cases. Conclusion The individualized strategy of uterine artery embolization should be advocated according to this angiographic classification of uterine myomata, the distal microsphere embolization have to be reasonably tailored in proportion to the concrete blood feeding ratio to the uterine fibroids by each side. The opaeifieation of ovarian branches of uterine artery or ovarian artery indicates that 〉 350 μm diameter microspheres should be used for the uterine artery embolization in order to protect the ovarian function. （J Intervent Radiol, 2006, 15： 274-277）

关 键 词：子宫肌瘤 血供分型 策略 栓塞治疗 

分 类 号：R737.33[医药卫生—肿瘤]