平阳霉素乳剂栓塞治疗子宫肌瘤的远期效果分析  

Long-term efficiency and safety of trans-catheter uterine artery embolization by lipiodol-pingyingmycin emulsion for uterine fibroids

作　　者：杜娟[1] 陈晓明[2] 李勇[2] 左约维[1] 洪淡华[1] 

机构地区：[1]广东省人民医院妇产科,广州510080 [2]广东省人民医院肿瘤中心介入治疗科,广州510080

出　　处：《影像诊断与介入放射学》2009年第1期36-40,共5页Diagnostic Imaging & Interventional Radiology

基　　金：广东省卫生厅高难;高新技术项目(C2000031);广东省医学科研课题(A2001065)

摘　　要：目的探讨碘油平阳霉素乳剂经导管子宫动脉栓塞(LPE-TUAE)治疗子宫肌瘤的远期疗效及安全性。方法243例子宫肌瘤患者行LPE-TUAE治疗,其中14例于栓塞后3d至6个月行妇科手术切除,标本送病检。另229例随访1～4年,观察症状改善、肌瘤大小与子宫体积变化、卵巢内分泌功能改变及术后并发症。结果月经恢复正常或经血显著减少占96.0%(193/201);下腹部、腰腿胀痛消失或明显缓解占94.9%(94/99),压迫症状消失或显著减轻占96.0%(48/50)。B超复查,栓塞后1年、2年、3年和4年肌瘤平均体积缩小率分别为60.7%、63.3%、65.6%和67.4%,子宫平均体积缩小率分别为49.6%、54.3%、55.2%和57.1%,栓后3～4年肌瘤复发率10.8%(12/111)。卵巢内分泌功能观察栓塞前后无显著变化。手术标本病理观察,碘油仅分布于肌瘤组织,栓后2周肌瘤出现点状坏死,3周出现大量片状坏死,而正常子宫肌组织未见坏死。未见严重并发症发生。结论LPE-TUAE治疗子宫肌瘤具有较好的远期疗效,对卵巢功能及正常子宫肌组织无明显损害,无严重并发症发生。Objective To investigate the long-term efficiency and safety of trans-catheter uterine artery embolization using lipiodol-pingyingmycin emulsion （LPE-TUAE） for uterine fibroids. Methods Two hundred and. forty-three patients with uterine fibroids were treated by LPE-TUAE. Fourteen of them underwent hysterectomy or myomectomy 3 days to 6 months after LPE-TUAE. The specimens were studied pathologically. Another 229 patients were followed up for 1 to 4 years to observe the long-term outcomes. Results Menorrhagia became normal or improved markedly in 96.0% （193/201）.Lumbago and lower abdominal pain disappeared or relieved markedly in 94.9% （94/99）.Bulk-related symptoms disappeared or lessened markedly in 96.0% （48/50）. Ultrasound revealed that the average decreased rate in the largest fibroid volume were 60.7% at 1 year, 63.3% at 2 year, 65.6% at 3 year and 67.4% at 4 year after embolization, and the average decreased rate in the largest uterine volume were 49.6% at 1 year, 54.3% at 2 year, 55.2% at 3 year and 57.1% at 4 year after embolization. Reoccurrence rate of myoma was 10.8% 3-4 year after embolization. No significant difference was found in hormone level between pre- and post-embolization. Pathological studies of specimens showed that lipiodol was only accumulated in ftbroids and was not seen in myometrium. Spotty necrosis 2 weeks after embolizaton and extensive patchy necrosis 3 weeks after embolization were occurred in fibroids. Necrosis was not showed in myometrium. No serious complications occurred. Conclusion LPE-TUAE possesses a good long-term effectiveness for uterine ftbroids, which doesn＇t cause the damage on ovarian function and normal myometrium or serious complications.

关 键 词：子宫肌瘤 栓塞 治疗性 随访研究 并发症 

分 类 号：R737.33[医药卫生—肿瘤] R735.705[医药卫生—临床医学]