子宫动脉栓塞治疗症状性子宫肌瘤的临床研究  

Clinical research of uterine artery embolization for symptomatic hysteromyoma

作　　者：屈文华[1] 郭平[1] 武永明[2] 

机构地区：[1]山西省大同市第五人民医院,030006 [2]大同大学医学院

出　　处：《实用医技杂志》2011年第6期573-576,共4页Journal of Practical Medical Techniques

摘　　要：目的探讨子宫动脉栓塞术(UAE)治疗症状性子宫肌瘤的临床效果。方法选择经B超和妇科检查确诊的50例症状性子宫肌瘤患者,采用Seldinger技术,经皮股动脉穿刺行双侧子宫动脉插管栓塞治疗。栓塞剂选用聚乙烯醇(PVA)颗粒联合明胶海绵颗粒或碘油平阳霉素乳剂联合明胶海绵颗粒。测量患者术前肌瘤体积大小、子宫体积大小、卵巢相关激素水平、月经量及血红蛋白的含量,对比术前、术后患者临床症状的改善情况,随访术后3、6、12个月肌瘤体积大小、子宫体积大小、卵巢相关激素水平变化及并发症的情况。结果 50例症状性子宫肌瘤患者,平均年龄(43±4)岁。手术插管、造影成功率100%,47例子宫肌瘤为双侧子宫动脉供血,3例为单侧子宫动脉供血,栓塞治疗后子宫肌瘤血供被完全阻断,临床症状改善明显,月经量减少、月经周期恢复正常、贫血改善(P<0.05),痛经、腰背部坠痛、尿频、便秘症状消失。术前子宫肌瘤平均体积为(61±17)cm3、子宫平均体积为(340±32)cm3,术后3、6、12个月随访显示,子宫体积缩小率为38.2%、46.7%、49.7%、子宫肌瘤体积缩小率为32.1%、65.9%、74.8%,均呈进行性减小,与术前比较差异有统计学意义(P<0.05),术后12个月总有效率为94%。术后1周患者均出现栓塞后综合征,包括疼痛(40/50)、发热(38/50)、胃肠道反应(24/50)、阴道不规则出血(43/50),对症处理后症状缓解或消失,除1例发生闭经外,其他无子宫内膜炎、子宫化脓症等严重并发症发生。关于卵巢内分泌功能相关激素水平的随访情况,雌二醇(E2)、促卵泡素(FSH)、黄体生成素(LH)水平术前与术后3、6、12个月比较差异无统计学意义(P>0.05)。结论子宫动脉栓塞治疗症状性子宫肌瘤可明显改善患者临床症状。具有高效、微创、并发症少等优点,是治疗子宫肌瘤的一种新的途径。Objective To investigate the therapeutic effect of uterine artery embolization（UAE） in treatment of symptomatic hysteromyoma.Methods Under the guidance of X-ray,the selective UAE were done in 50 Patients with symptomatic hysteromyoma who were diagnosed by gynaecologist and measured by sonography.Embolizing agents include Polythene vinyl alcohol（PVA）,Pingyangmycin,super lipiodol emulsion and gelatin sponge particles.To measure the pati-ents′ hysteromyoma and uterine volume,the level of hormone about ovary [estradiol（E2）,follicle-stimulating hormone（FSH）,luteinizing hormone（LH）],the amount of menses and protoferriheme before UAE,to compare the change of the patients′ clinical symptoms before and after UAE.Fifty patients were followed up for 3,6,12 months about their hystero-myoma and uterine volume,the level of hormone about ovary（E2,FSH,LH） and complication after UAE.Results Fifty patients with symptomatic hysteromyoma were performed with UAE,the average（43±4） years.The success rate of uterine artery angiography was 100%（50/50）.Angiography revealed a rich blood supply of 47 cases patents′ uterine fibroids by bilateral uterine artery,3 cases patents′ uterine fibroids were supplied by single uterine artery.Bilateral uterine arteries were embolized after UAE,the clinical symptoms were obviously improved,and patients returned to normal menstrual cycle,anaemia were improved（P0.05）.The average volume of hysteromyoma before UAE is（61±17） cm3,the average volume of womb before UAE is（340±32） cm3.After UAE 50 patients were followed up for 3,6,12 months,the remission rate of uterine volume was 38.2%,46.7%,49.7%,the remission rate of hysteromyoma was 32.1%,65.9%,74.8%.The difference is statistical significant（P0.05） compa-ring with pro-UAE.The total effective rate was 94% 12 months after UAE.There was post embolization comprehensive symptom including pain（40/50）,fever（38/50）,gastrointestinal symptom（24/50）,vagino bleeding（43/50） 1 week after UAE,the sy

关 键 词：平滑肌瘤 子宫动脉栓塞 介入治疗 

分 类 号：R737.33[医药卫生—肿瘤]