子宫动脉栓塞治疗子宫肌瘤的生命质量观察

目的 探讨子宫动脉栓塞前后子宫肌瘤患者的生命质量变化.方法 对2003年1月-2005年3月我院收治118例行子宫动脉栓塞术患者,应用子宫肌瘤症状和生命质量(UFS-QOL)调查表评价其术前及术后生命质量的变化,并对患者进行满意度调查.同时观察子宫及肌瘤大小变化.结果 术后6个月肌瘤及子宫体积平均分别缩小49.6%和45.2%.栓塞术后患者临床症状明显好转,生命质量各因子评分均较术前明显提高,差异均有统计学意义(P＜0.001),65%患者临床症状明显改善,接近80%患者肯定或很可能再次选择UAE治疗子宫肌瘤.结论 行UAE治疗子宫肌瘤,可明显提高患者的生命质量,有较高的满意度.     

腹腔镜下子宫肌瘤剔除术与子宫动脉栓塞术治疗子宫肌瘤疗效比较研究

目的比较腹腔镜下子宫肌瘤剔除术和子宫动脉栓塞术治疗子宫肌瘤的疗效。方法回顾性分析自2014年1月至2016年6月沈阳市第六人民医院收治的88例子宫肌瘤患者的临床资料,按照术式不同,分为腹腔镜下子宫肌瘤剔除术组(A组,n=42)和子宫动脉栓塞术组(B组,n=46)。比较两组患者围术期不良反应以及随访3、6、12个月的临床症状改善情况、子宫和肌瘤体积变化情况、生存质量情况。结果所有患者围术期均未发生明显不良反应。随访期间,B组月经量增多、痛经症状改善情况明显好于A组,差异有统计学意义(P<0.05),但两组经期延长、贫血、尿路和直肠压迫、盆腔疼痛症状改善情况比较,差异无统计学意义(P>0.05);A组子宫和肌瘤体积缩小比例明显高于B组,差异有统计学意义(P<0.05);B组生存质量改善情况明显好于A组,差异有统计学意义(P<0.05)。结论腹腔镜下子宫肌瘤剔除术和子宫动脉栓塞术治疗子宫肌瘤疗效均良好。     

中药白及微粒与真丝线段栓塞子宫肌瘤的对比研究

目的:评价中药白及微粒与真丝线段栓塞子宫动脉治疗子宫肌瘤的临床疗效及不良反应。方法:28例子宫肌瘤患者随机分为2组(每组14例),分别采用中药白及微粒与真丝线段栓塞剂行双侧子宫动脉栓塞治疗。术后观察各自并发症并随访观察3月后月经恢复情况及6月和12月后B超复查瘤体大小变化。结果:白及微粒组与真丝线段组治疗子宫肌瘤的临床疗效无显著性差异(P>0.05),白及微粒组术后并发症较真丝线段组明显减少(P<0.01)。结论:中药白及微粒是治疗子宫肌瘤非常理想的栓塞剂。     

经皮骨成形术联合动脉化疗栓塞治疗骨盆骨转移瘤

目的比较经皮骨成形术和经皮骨成形术联合动脉化疗栓塞治疗骨盆骨转移瘤的临床疗效。方法 92例骨盆骨转移瘤患者,按治疗方案分为两组,对照组46例应用经皮骨成形术治疗,观察组46例应用经皮骨成形术联合动脉化疗栓塞术治疗。统计并比较分析两组患者疼痛目测类比评分、Karnofsky功能状态评分、MDA评价。结果 1)两组患者均顺利完成手术治疗; 2)两组患者治疗后的疼痛目测类比评分、Karnofsky功能状态评分均较治疗前改善(P 0. 05),两组组间比较差异无显著性意义(P 0. 05); 3) MDA评价,实验组术后1个月和3个月骨转移瘤客观缓解率为78. 26%和69. 57%,高于对照组的54. 35%和47. 83%,2组比较差异有显著性意义(P 0. 05)。结论经皮骨成形术联合动脉化疗栓塞术对骨盆骨转移瘤的治疗有较好的效果,值得临床推广应用。     

子宫肌瘤介入治疗前后CT动态扫描血供变化的研究

目的 研究子宫肌瘤介入治疗前后子宫与肌瘤血供变化。方法 16例单发症状性子宫肌瘤患者接受子宫动脉栓塞治疗，术前、术后7d及术后3个月选择同层面进行CT动态增强扫描，测量正常子宫及肌瘤的CT值，进行栓塞前后对比分析。结果 16例患者每次均顺利完成CT动态增强扫描，术前、术后7d及术后3个月正常子宫组织动态增强曲线及CT值无明显改变，而肌瘤动态增强曲线及CT值有明显改变，肌瘤栓塞后处于持续性缺血状态。结论 子宫动脉栓塞术治疗子宫肌瘤是一种安全，有效的新疗法，子宫动脉栓塞后非肌瘤子宫组织血供不受影响。     

子宫动脉栓塞治疗子宫肌瘤的动态影像学监测及其机制研究

目的观察子宫动脉栓塞治疗子宫肌瘤术前、术后影像学动态变化,探讨其治疗机制。方法通过对45例子宫肌瘤患者行子宫动脉栓塞治疗,观察栓塞前后行盆腔彩色多普勒超声(彩超)、MR平扫加增强,以及栓塞后CT平扫检查,了解子宫及肌瘤影像学征象的动态变化。追踪时间3～16个月,平均(10.0±3.5)个月。结果术前41例彩超显示肌瘤血流丰富,术后第1天肌瘤和正常肌层血流消失,第7天肌瘤血流仍消失但正常子宫肌层血流开始出现;术后1、3、12个月正常子宫肌层血流恢复正常而肌瘤内仍无血流。4例术后第7天开始肌瘤内有血流信号,至术后12个月肌瘤内仍有血供。45例CT平扫发现术后当天肌瘤和正常肌层均有碘油沉积,以肌瘤明显,术后1、3、12个月正常子宫肌层碘油逐渐流失,而肌瘤内仍有碘油沉积。45例术前MRI肌瘤及子宫肌层均有明显强化,术后3个月MRI复查39例肌层有强化而肌瘤无强化改变;另6例术后肌瘤仍有不同程度强化。2例患者术后肌瘤脱落,病理证实为坏死组织。术前、术后肌瘤体积变化的监测,MRI与彩超测量结果的比较差异无统计学意义(P>0.05)。结论子宫肌瘤血管床出现选择性栓塞导致肌瘤坏死,是子宫动脉栓塞治疗子宫肌瘤的机制。其动态影像...     

子宫动脉栓塞术前后性激素水平的变化

目的　探讨子宫动脉栓塞术前后性激素的变化。方法　对 2 7例子宫肌瘤进行子宫动脉栓塞治疗 ,测定术前后黄体生成素 ,促卵泡素 ,雌二醇等水平。结果　促卵泡素术前为 (8.6 3± 10 .33)IU/L ,术后 3个月 (15 .8± 2 7.89)IU/L ;促黄体生成素术前 (11.77± 12 .2 1)IU/L ,术后 3个月 (2 5 .79±37.2 4 )IU/L ;雌二醇术前 (16 0± 6 7) pg/ml,术后 3个月 (184± 87) pg/ml(P >0 .0 5 ,t检验 )。手术前后黄体生成素 ,促卵泡素 ,雌二醇差异无显著性 ;其中 2例出现绝经期的变化。结论　子宫动脉栓塞对性激素影响不大。     

超声在子宫肌瘤的子宫动脉栓塞术疗效评价中的价值

目的:探讨超声在子宫动脉栓塞术治疗子宫肌瘤术后疗效随访中的应用价值。材料和方法:58例子宫肌瘤患者分别在栓塞术前1周、术后1个月、6个月、12个月运用超声观察子宫大小形态、肌瘤大小形态和血流动力学的改变。结果:术后1个月子宫体积平均缩小44.24%,肌瘤体积平均缩小43.74%;术后6个月子宫体积平均缩小62.72%,肌瘤体积平均缩小61.25%;术后1年子宫体积平均缩小72.17%,肌瘤体积平均缩小70.18%。其中以单发肌瘤、内膜肌瘤患者疗效明显,肌瘤的血供较术前明显减少。结论:超声在评价子宫动脉栓塞术治疗子宫肌瘤术后疗效中有重要价值。     

子宫肌瘤栓塞治疗机理的影像学研究

目的从影像学角度探讨子宫动脉栓塞治疗子宫肌瘤的机理.资料与方法通过对25例子宫肌瘤进行子宫动脉栓塞,栓塞前后对子宫及子宫肌瘤行CT平扫、彩色多谱勒超声和磁共振成像检查.栓塞治疗前行组织病理活检.追踪时间3～18个月,平均(6±3.7)个月.结果彩色多谱勒检查发现,术前肌瘤血流丰富,术后当天肌瘤和正常肌层血流消失,术后第5天肌瘤血流仍然消失但正常子宫肌层血流开始出现,术后1、3、6、12个月正常子宫肌层血流恢复正常而肌瘤血流仍然消失.CT平扫发现,术后当天肌瘤和正常肌层均有碘油沉积,以肌瘤明显、正常肌层较少,术后1、3、6、12个月正常子宫肌层碘油流失而肌瘤仍然有碘油沉积.术后3个月盆腔MRI检查发现,术前肌瘤及子宫肌层均有明显强化,术后3个月肌层仍有强化但肌瘤没有强化.所有子宫肌瘤患者均由病理活检确诊.结论子宫肌瘤血管床被栓塞导致坏死是子宫动脉栓塞治疗子宫肌瘤的机理.子宫正常肌层血供没有受影响.     

经阴道彩色能量多谱勒超声在子宫肌瘤栓塞中的作用

目的探讨经阴道彩色能量多谱勒超声在子宫肌瘤栓塞治疗中的作用。资料与方法通过对27例子宫肌瘤患者进行子宫动脉栓塞治疗,并应用经阴道彩色能量多谱勒超声在栓塞前、栓塞后当天、第5d、栓塞半年内每次月经干净后第3～4d内及栓塞后每年进行检查,追踪随访34～58个月。结果栓塞前月经量过多19例,术后3个月内月经量恢复正常18例。监测发现,栓塞前肌瘤部分血流信号丰富22例,一般2例,稀少但肌瘤周边有环状血流信号2例和无血流信号1例;子宫肌层血流信号均丰富。26例栓塞后超声发现肌瘤一直无血流信号,子宫肌层血流信号在术后第5d后的每次复查均丰富。栓塞术后症状无改善1例,术后第5d和1个月发现肌瘤血流信号较丰富与术前相近。栓塞前均可探测典型的子宫动脉频谱,栓塞后子宫动脉频谱消失,在栓塞后半年到2年内子宫动脉复通。随访期内出现临床症状的再发肌瘤2例,没有临床症状但超声检查发现再发肌瘤2例。子宫体积缩小率(50.89±1.63)%(t值3.921,P<0.001),子宫肌瘤体积缩小率(56.76±7.94)%(t值4.643,P<0.001),半年后肌瘤和子宫的体积维持稳定,没有变化。结论术前对子宫肌瘤进行血流信号的检测有利于术前对肌瘤栓塞疗效的判断;术后对子宫和肌瘤的短期(栓塞后1周内)动态监测有助于对肌瘤栓塞疗效的分析;术后定期对肌瘤行超声检查有利于子宫肌瘤再发的监测。     

Initial experience with use of tris-acryl gelatin microspheres for uterine artery embolization for leiomyomata

PURPOSE: To assess the safety and effectiveness of tris-acryl gelatin microspheres (Embospheres) in the treatment of leiomyomata by uterine artery embolization. MATERIALS AND METHODS: This was a Phase I study of 30 patients with symptomatic leiomyomata. Each patient underwent ultrasound imaging and completed questionnaires regarding symptoms and health status at baseline and 3 and 6 months after treatment. Bilateral embolization was performed with use of tris-acryl gelatin microspheres. Summary statistics were used to characterize the demographic and procedure data. Paired t-tests were used to assess change in the severity of menstrual bleeding and health-related quality of life. RESULTS: Bilateral embolization was technically successful in all patients. Three months after treatment, menstrual bleeding was markedly improved as assessed by menorrhagia questionnaire (P <.0001) and menstrual calendar (P <.0001). Pelvic pain and discomfort was improved in 92% of cases. Physical component summary scores of the SF-12 also increased from baseline at 3 months (P =.02) and at 6 months (P =.01). Minor complications occurred in nine patients; there were no major complications. CONCLUSION: Although limited, this initial experience suggests that tris-acryl gelatin microspheres are an effective and safe embolic agent for the treatment of uterine leiomyomata.     

Uterine fibroid embolization: measurement of health-related quality of life before and after therapy

OBJECTIVE: To determine the change in health-related quality of life associated with uterine fibroid embolization (UFE). MATERIALS AND METHODS: A health-related quality-of-life questionnaire was administered before and after therapy. The questionnaire contained validated scales from the Medical Outcomes Study, with additional domains and symptom items specific to fibroids. Patients treated with UFE for symptomatic uterine leiomyomata completed a health-related quality of life questionnaire before therapy. A follow-up quality of life questionnaire and an additional brief questionnaire to assess symptom improvement were completed 3 and 6 months postprocedure. Confirmatory reliability and validity testing was also conducted. Mean scores for each scale on the quality of life questionnaire were calculated and change scores were computed. RESULTS: Fifty women were enrolled in the study and completed the baseline assessment. Health-related quality of life scores improved in all instances at follow-up. Mean change scores were statistically significant for all domains between baseline and month 3 (P < .01) and between baseline and month 6 (P < .05) except backache (P = .12). CONCLUSION: Patients undergoing UFE report significant improvements in health-related quality of life and fibroid-specific symptoms. These findings suggest that the measurement of health-related quality of life may be an effective means of comparing the outcome of UFE with other fibroid therapies.     

Long-term outcome of uterine artery embolization for symptomatic uterine leiomyomas

PURPOSE: To evaluate long-term outcomes and factors associated with treatment failure after uterine artery embolization (UAE) in women with symptomatic uterine leiomyomas. MATERIALS AND METHODS: One hundred consecutive women treated with UAE for symptomatic uterine leiomyomas participated. Clinical outcome data (ie, changes in symptoms, menstrual status, subsequent therapies) and satisfaction data were collected. Treatment failure was defined by subsequent major surgery (ie, hysterectomy or myomectomy), a second embolization, or a lack of symptom improvement at the patient's final follow-up interval. Possible predictors of failure were age, clinical baseline characteristics (ie, bleeding, pain, and bulk), and imaging results (eg, percent volume reduction of the dominant tumor). Cox proportional-hazards analysis was used to determine factors associated with failure. RESULTS: Follow-up was available in 93 women (median follow-up, 54 months; range, 45-87 y). Continued symptom relief was observed in 72% of patients (n = 67). Among the 26 women with treatment failure (28%), 11 (42%) underwent hysterectomy, four (15%) myomectomy, and eight (31%) repeat embolization. Three (12%) reported no improvement. In women without any additional surgery (n = 70), heavy menstrual bleeding, pain, and bulk-related symptoms improved in 97%, 93%, and 92%. Ninety percent of all women (n = 93) were satisfied or very satisfied at final follow-up. Predictors of failure were a lack of improvement in bleeding (hazard ratio [HR], 9.0; 95% CI, 3.1-26.3; P < .001) or pain (HR, 7.4; 95% CI, 2.2-24.4; P < .001) at 1 year after UAE and the percent reduction in dominant tumor volume (HR, 0.97; 95% CI, 0.95-0.99; P = .007). CONCLUSIONS: UAE in women with symptomatic leiomyomas leads to long-term symptom improvement. Predictors of failure were a lack of improvement in bleeding or pain at 1 year and the percent reduction in dominant tumor volume.     

Acrylamido polyvinyl alcohol microspheres for uterine artery embolization: 12-month clinical and MR imaging results

PURPOSE: To report the 12-month clinical and magnetic resonance (MR) imaging results of an ongoing two-center registry involving acrylamido polyvinyl alcohol (PVA) microspheres for uterine artery embolization (UAE) for leiomyomas. MATERIALS AND METHODS: A total of 69 patients underwent UAE with 500-700-microm, 700-900-microm, and 900-1,200-mum acrylamido PVA microspheres (BeadBlock). Thirty-three patients underwent UAE with a limited embolization (protocol A) and 36 patients underwent UAE with stasis as the angiographic endpoint (protocol B). Primary objectives were clinical efficacy measured by a leiomyoma-specific quality of life (QOL) questionnaire and infarction rate of leiomyomas on early contrast agent-enhanced MR imaging. Secondary objectives were in-hospital complications, patient satisfaction, and frequency of clinical failure. RESULTS: Bilateral embolization was technically successful in 68 of 69 patients. A significant decrease (P < .001) in symptom severity and increase in health-related QOL was observed at 3 and 12 months with no significant differences between embolization protocols. However, contrast agent-enhanced MR imaging showed a significantly lower rate of completely infarcted leiomyomas in protocol A compared with protocol B (P < .05). Early clinical failures in patients treated according to protocol A were caused by incomplete tumor infarction. Minor complications occurred in five of 69 patients. Patient satisfaction was similar between protocols. CONCLUSIONS: Acrylamido PVA microspheres are a clinically effective and safe embolic agent for UAE. The use of 500-700-microm spheres and a limited embolization results in an unacceptably high rate of failed tumor infarction. Superior imaging results and fewer repeat interventions can be achieved with use of 700-900-microm spheres and stasis as the angiographic endpoint.     

Uterine arterial embolization for leiomyomas: perfusion and volume changes at MR imaging and relation to clinical outcome

PURPOSE: To monitor changes in perfusion and volume of uterus and leiomyomas after bilateral uterine artery embolization (UAE) and to correlate immediate perfusion changes with subsequent reduction in leiomyoma volume and clinical outcome. MATERIALS AND METHODS: Eleven consecutive women underwent magnetic resonance (MR) imaging before UAE, immediately after, and at 1 and 4 months. Reduction in maximal enhancement above baseline at 90 seconds (ME(90)) after injection of the dominant leiomyoma immediately after embolization was correlated with its volume reduction at 4 months and with clinical response at 12 months. RESULTS: Forty-five leiomyomas were noted (mean, four per patient). Myometrium enhanced briskly (ME(90) of 110%), with a reduction in ME(90) to 26% immediately after embolization. Initial leiomyoma ME(90) was lower (P <.001), but it suppressed to baseline levels immediately after embolization. At 1 and 4 months, myometrial perfusion returned to normal, but leiomyoma perfusion remained suppressed (P <.001). Immediate reduction in leiomyoma ME(90) correlated with clinical response (Spearman rho = 0.64). Leiomyomas initially high in SI on T2-weighted images showed significantly greater volume reduction than those low in SI (P =.006). Well-perfused leiomyomas did not show greater volume reduction than those that were poorly perfused. Volume reduction did not correlate with improvement in clinical symptom score. CONCLUSION: Immediate reduction in leiomyoma perfusion after bilateral UAE correlates with clinical response, whereas leiomyomas initially high in SI on T2-weighted images indicate a likely greater volume reduction.     

Uterine artery embolization for symptomatic adenomyosis with or without uterine leiomyomas with the use of calibrated tris-acryl gelatin microspheres: midterm clinical and MR imaging follow-up

PURPOSE: To evaluate clinical and magnetic resonance (MR) imaging results after uterine artery embolization (UAE) in women with symptomatic adenomyosis with or without uterine leiomyomas. MATERIALS AND METHODS: Thirty-eight women with symptomatic adenomyosis with or without uterine leiomyomas were treated with UAE with calibrated tris-acryl gelatin microspheres. Based on MR findings, women were categorized as having pure adenomyosis (group A; n = 15), adenomyosis dominance with fibroid tumors (group B; n = 14), or fibroid tumor dominance with adenomyosis (group C; n = 9). RESULTS: Heavy menstrual bleeding, pain, and bulk-related symptoms at last follow-up at a median of 16.5 months (range, 3-38 months) were compared with baseline symptoms. With follow-up MR imaging at a median of 12 months (range, 3-36 months), changes in uterine volume, leiomyoma volume, junctional zone thickness, and contrast enhancement of adenomyosis were assessed. After embolization, adenomyosis infarction could be depicted on contrast medium-enhanced MR in 44.1% of cases. Median reductions of uterine volume, fibroid tumor volume, and junctional zone thickness were 44.8%, 77.1%, and 23.9%, respectively. In group A, three patients needed additional surgery after UAE, in addition to two in group B and one in group C. In the remaining 32 patients, except for one patient in group C, all preexisting symptoms (eg, bleeding, pain, bulk-related symptoms) improved or resolved after UAE. Overall, 84.2% of women were satisfied with the results of UAE. CONCLUSION: In this study, midterm results (at a median of 16.5 months) showed that UAE in symptomatic adenomyosis with or without uterine leiomyomas is effective. Hysterectomy was avoided in the vast majority of patients. MR imaging showed reduction of uterine volume and junctional zone thickness.     

Leiomyoma recurrence after uterine artery embolization

PURPOSE: The purpose of this study was to evaluate the rate of leiomyoma recurrence after uterine artery embolization (UAE) for symptomatic uterine leiomyomas. MATERIALS AND METHODS: A prospective study of UAE of uterine leiomyomas has been ongoing at the authors' hospital since 1997. The recurrence rate was assessed in June 2002. Vascular access was obtained via the right common femoral artery and free-flow embolization was performed with use of 150-250- micro m polyvinyl alcohol particles and an absorbable particle sponge. Follow-up included clinical and ultrasound (US) examinations at 3, 6, and 12 months, and once per year thereafter. RESULTS: Eighty-five UAE procedures were performed between January 1997 and June 2000. Five patients were lost to follow-up. Median follow-up was 30 months (range, 2-57 months). There were six immediate failures: one technical failure, three cases of concomitant disease (one case of endometrial cancer and two cases of adenomyosis), and two cases of large subserosal leiomyomas. There were eight late failures or recurrences: one case of leiomyoma progression, seven cases of new leiomyomas. Mean time to recurrence was 27.4 months. CONCLUSIONS: Although UAE is an effective primary treatment for leiomyomas, this study recorded a recurrence rate of 10% at just more than 2 years. Clinical and US examinations are needed before UAE to exclude pedunculated submucosal leiomyomas and cancers, and must be repeated for more than 2 years after UAE to monitor patients' progress. Longer follow-up and more events are needed to define risk factors for recurrence.     

Polyvinyl alcohol particles and tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a randomized comparative study

PURPOSE: To determine if the type of embolic material used for uterine artery embolization (UAE) for leiomyomas has an impact on short-term recovery or the effectiveness of embolization. MATERIALS AND METHODS: One hundred patients were randomly assigned to undergo UAE with polyvinyl alcohol (PVA) particles or tris-acryl gelatin microspheres. Short-term, in-hospital medication use and pain levels were recorded. After discharge, symptom severity, temperature, and medications used were recorded daily for 1 week and symptom levels were measured for weeks 2-4. Three months after embolization, contrast material-enhanced magnetic resonance imaging examinations were evaluated blindly to determine the extent of leiomyoma infarction. Symptom and quality of life (QOL) status was determined with use of questionnaires. Analysis was completed with use of chi(2) analysis, Fisher exact tests, Student t tests, and analysis of variance as appropriate. Regression analysis was used to analyze the impact on outcome of baseline factors (other than type of embolic agent). RESULTS: No significant differences were noted at baseline between the two treatment groups. On average, there were significantly higher volumes of tris-acryl microspheres used (9.0 mL vs 3.0 mL; P =.0001), whereas microcatheter occlusion was more common with PVA (28% vs 4%, P =.001). There were no differences in pain severity, other postprocedural symptoms, or medication use between the two treatment groups. There were also no differences in the frequency of incompletely infarcted leiomyomas, degree of improvement in symptom score, patient satisfaction, or QOL. CONCLUSION: No substantive differences were detected between outcomes of embolization with PVA particles or tris-acryl gelatin microspheres.     

平阳霉素碘油乳剂子宫动脉栓塞治疗症状性子宫肌瘤

目的 评价平阳霉素碘油乳剂（Ｐｉｎｙａｎｇｍｙｃｉｎ ｌｉｐｉｏｄｏｌ ｅｍｕｌｓｉｏｎ,ＰＬＥ）子宫动脉灌注对症状性子宫肌瘤的疗效和副作用。方法 对２５例症状性子宫肌瘤患者进行选择性子宫动脉ＰＬＥ灌注,随访３～１８个月,平均６个月,观察术后症状缓解情况和子宫缩小程度。结果 除２例仅完成单侧操作外,其余均治疗成功。子宫肌瘤的动脉造影表现为子宫动脉明显增粗,分支数量增多、纡曲。子宫体增大,染色明显并