子宫动脉栓塞治疗子宫肌瘤对女性激素的影响

目的 探讨子宫动脉栓塞术(UAE)治疗子宫肌瘤对女性分泌功能的影响.方法 31例子宫肌瘤患者行UAE后随访3～6个月,观察月经变化及监测血清卵泡刺激素(FSH)、黄体生成素(LH)、孕酮(Prog)、雌二醇(E2)4种性激素变化.同时于介入手术前及术后3、6个月分别行B超检查测定肌瘤体积及肌瘤的供血状况.结果 25例(80.6%)UAE后恢复正常月经,临床症状明显改善,4例(12.9%)有一过性月经紊乱(3～6个月恢复正常),2例(0.06%)出现闭经(年龄45岁、49岁).31例患者4种血清性激素术前、术后变化差异无统计学意义(P＞0.05).结论 UAE是一种有效的治疗手段,对女性血清性激素无明显影响,但年龄大于45岁以上者可能出现闭经.     

子宫动脉栓塞后暂时或永久闭经与卵巢功能的关系

目的对子宫动脉栓塞(UAE)治疗后出现暂时和永久闭经的病例进行分析,研究其与卵巢功能减退或衰竭的关系。方法287例行UAE,10例出现闭经,其中6例为暂时闭经,4例为永久闭经,永久闭经者年龄分别为38、47、48和48岁。观察治疗前后月经改变、血FSH变化,并分析相关因素如术前手术史等。结果暂时闭经患者在术后6个月内月经恢复,血FSH治疗前后差异无显著性;永久闭经患者血FSH治疗前后有显著性差异,治疗后均>20u/L,1例24个月时>100u/L;其中1例,38岁,曾行双侧卵巢手术。结论暂时闭经并不一定表明卵巢功能减退或衰竭。UAE后出现卵巢功能减退或衰竭的概率较低,且多数发生在近绝经期的患者,对曾行双侧卵巢手术的患者行UAE,由于可能引起卵巢早衰,要特别慎重。     

子宫动脉栓塞术:两种栓塞剂对卵巢功能影响的对比研究

目的:探讨超液化碘化油、平阳霉素混合液在子宫肌瘤栓塞术中对卵巢功能的影响.方法:将83例子宫肌瘤患者分成两组进行栓塞治疗,其中A组(42例)采用聚乙烯醇微粒(直径500～700μm)作为栓塞剂,另外B组(41例)采用超液化碘化油和平阳霉素混合液作为栓塞剂.观察栓塞前后血清FSH、LH、E2水平变化及并发症发生的情况.结果:两组栓塞前及栓塞后3个月、6个月血清性激素变化没有统计学差异(P>0.05),B组出现1例永久性闭经及1例膀胱损伤.结论:从近期追踪观察来看聚乙烯醇和碘油、平阳霉素混合液两种栓塞剂在子宫肌瘤栓塞中对卵巢功能的影响没有统计学差异,但因为碘油的液体特性,一旦发生误栓易出现严重并发症,因此应慎重选择.     

子宫肌瘤栓塞中误栓卵巢支对卵巢功能的影响

目的评价子宫肌瘤栓塞中双侧卵巢支被误栓对卵巢功能的影响.方法将在子宫动脉造影中出现双侧卵巢支显影而被误栓的15例子宫肌瘤栓塞病人分成2组,1组是双侧卵巢区有碘油沉积(双侧卵巢碘油沉积组),另1组是双侧卵巢区无碘油沉积、或仅一侧卵巢区有碘油沉积(非双侧卵巢碘油沉积组),分别统计术后闭经的病例,并作Fisher检验.栓塞材料采用超液化碘油和平阳霉素混合液.栓塞前和栓塞6个月后检查促卵泡生成素(FSH)、黄体生成素(LH)和雌二醇(E2),并作t检验.结果 15例年龄26～46岁[(39.00±5.62)岁],追踪16～47个月[(30.5±6.4)个月].12/15的患者月经在栓塞后2～6周[(3.0±0.3)周]恢复,3/15的患者出现闭经,3例术后闭经的性激素呈绝经期改变.双侧卵巢碘油沉积组出现术后闭经(3/3),非双侧卵巢碘油沉积组未出现术后闭经(0/12),两组差异有统计学意义(P=0.002 19).≥45岁的患者有2例,均无术后闭经,<45岁的患者有13例,其中3例出现术后闭经.所有患者在栓塞前和栓塞6个月后的FSH、LH和E2差异无统计学意义(P>0.05).结论子宫肌瘤栓塞中双侧卵巢支被误栓后,若双侧卵巢区被碘油沉积,术后发生闭经的几率极高.若子宫动脉造影中出现双侧卵巢支显影的肌瘤患者,需要慎重选择栓塞剂,超液化碘油可能不是合适的栓塞材料.单纯的双侧子宫动脉卵巢支的误栓,即没有卵巢血管床的误栓情况下,对卵巢功能的影响可能较小.     

基于全外显子组测序技术下早发性卵巢功能不全致病基因研究进展

<正>早发性卵巢功能不全(premature ovarian insufficiency,POI)定义为女性在40岁之前卵巢性激素水平分泌不足导致卵巢功能减退和更年期提前^[1-2]。目前,全球临床公认的POI诊断标准包括：40岁之前出现连续4个月以上的闭经或月经稀发,间隔1个月以上连续两次血清促卵泡激素水平>25 IU/L^[3]。     

高压明胶海绵微粒动脉内栓塞治疗子宫肌瘤的临床观察

目的:评价高压明胶海绵微粒作为栓塞剂动脉内栓塞治疗症状性子宫肌瘤的安全性和有效性。方法:用高压明胶海绵微粒动脉内栓塞治疗173例子宫肌瘤患者,随访3~36个月,平均15.7个月,观察临床疗效、肌瘤和子宫体积的变化。结果:术后4个月总的症状改善率98.84%(171/173),160例(92.49%)患者术后月经完全恢复正常;5例(2.89%)患者出现术后永久闭经;痛经与直肠和膀胱压迫等症状均完全消失。术后6个月子宫体积平均缩小49.35%,肌瘤平均缩小59.78%。结论:采用高压明胶海绵微粒作为栓塞剂栓塞子宫动脉治疗症状性子宫肌瘤是一种经济、安全、有效的新方法。     

栓塞子宫动脉及供应子宫肌瘤的卵巢动脉治疗子宫肌瘤前瞻性研究

目的 观察有卵巢动脉供血的子宫肌瘤采用栓塞子宫动脉及供应子宫肌瘤的卵巢动脉的疗效及其对卵巢功能的影响.方法 用前瞻性研究方法对26例MR检查确诊有卵巢动脉供血的子宫肌瘤采用栓塞子宫动脉及供应子宫肌瘤的卵巢动脉,观察栓塞前、后不同时间卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)水平及子宫体积及肌瘤体积的变化.结果 患者术后1周至3个月FSH、LH增高,E2降低,术后6个月左右卵巢功能恢复正常,其中8例有明确的卵巢功能减退症状,但均为可逆性,无严重后果,2例继发闭经,考虑术后卵巢功能衰竭的发生与年龄有关,栓塞后子宫体积及肌瘤体积明显缩小.结论 有卵巢动脉供血的子宫肌瘤采用栓塞子宫动脉及供应子宫肌瘤的卵巢动脉,是安全和有价值的.     

经导管子宫动脉栓塞治疗子宫肌瘤并发闭经的原因分析

目的 探讨经导管子宫动脉栓塞（TUAE）治疗子宫肌瘤并发闭经的原因。方法 搜集1999年4月至2004年5月，接受TUAE治疗的子宫肌瘤患者231例，年龄29～51岁，平均39．5岁。TUAE均采用经导管双侧子宫动脉注射碘油-平阳霉素乳剂的方式，其中碘油用量6～20ml，平阳霉素用量8～16mg，231例中186例加用明胶海绵颗粒果栓塞。结 231例中2例分别于TUAE后3和4个月发生闭经，发生率0．87％。1例考虑为卵巢功能受损引起的闭经，表现为雌二醇（E2）下降，促卵泡成熟激素（FSH）增高，经过1年的雌孕激素序贯治疗，患者月经逐渐恢复正常；另1例经宫腔镜证实为子宫内膜萎缩所致。结论 TUAE后极少数人可发生闭经，其原因与卵巢功能受损及子宫内膜萎缩有关。     

子宫肌瘤栓塞治疗的中长期临床观察

目的评价子宫肌瘤栓塞治疗的中长期疗效。方法对110例子宫肌瘤患者栓塞治疗,并追踪观察,追踪时间48～72个月,采用经阴道彩色超声复查,栓塞剂采用超液化碘油和平阳霉素混合液(51例)和聚乙烯醇微粒(直径350～700μm,59例),观察其中长期临床疗效,并发症,性激素变化,怀孕妊娠分娩和肌瘤的再发情况等。结果110例均进行了双侧子宫动脉栓塞,月经量过多症状改善有效93/94(98.93%),压迫症状改善26/26(100%)。子宫体积减少51.5%±3.1%(t值2.861,P<0.01)。肌瘤体积减少64.2±6.6%(t值2.664,P<0.01)。栓塞前后黄体生成素、促卵泡素和雌二醇水平差异无显著性。栓塞后腹痛6/110(5.5%);发热90/110(81.8%);阴道出血95/110(86.4%);血尿11/110(10.0%);膀胱误栓1/110(0.9%);短暂性闭经3/110(2.7%)和卵巢衰竭永久性闭经3/110(2.7%)。手术失败率1/110(0.9%),肌瘤栓塞后2年再发率为4/110(3.6%)。栓塞后5例子宫肌瘤患者7次怀孕,其中4例患者分娩4次,同一患者先后人工流产3次,怀孕期间和分娩后,B超复查没有发现子宫肌瘤增大或出现新发子宫肌瘤。结论子宫肌瘤栓塞的中长期疗效肯定。子宫肌瘤栓塞后有一定的再发率。子宫肌瘤栓塞对卵巢功能的影响较轻。子宫肌瘤栓塞后妊娠和分娩仍较安全。     

卵巢早衰小剂量激素替代治疗32例观察

近年来 ,卵巢早衰的发病有上升趋势 ,绝经是卵巢功能衰竭的重要标志 ,雌激素水平低下和促性腺激素水平升高 ,并年龄在 4 0岁以前是其特点。对于治疗 ,国外文献报告提法较多。现将我院 1 990年 1 1月～ 1 999年 6月共收治的继发闭经 2 0 3例 (不含子宫性闭经 ) ,确诊为卵巢早衰 4 8例 ,能坚持小剂量激素替代治疗 2ａ以上的 3 2例 ,总结报告如下。1　临床资料1 1　一般资料　绝经年龄最小 3 0岁 ,最大 3 9岁 ,平均年龄 3 5岁。就诊时闭经年限为 6个月～ 5ａ,平均 2 78ａ。闭经前均有月经稀发渐至闭经史。本组已婚 3 1例 ,未婚 1例 ,未孕 1例…     

Uterine artery embolization treatment of uterine fibroids: effect on ovarian function in younger women

PURPOSE: To evaluate how uterine artery embolization (UAE) treatment for uterine fibroids (UF) affects ovarian function in young Middle Eastern women. MATERIALS AND METHODS: In this prospective study, 32 patients (mean age, 34 y; range, 26-45 y) underwent UAE treatment of symptomatic fibroids. Serum follicle-stimulating hormone (FSH) levels were measured before and after the embolization treatment. Preprocedural levels were determined on the second day of the menstrual cycle. Postprocedural levels were measured 3 months and 6 months after embolization. A detailed history of menstrual cycles was obtained before and after UAE. RESULTS: Thirty premenopausal patients had normal menses before UAE. Mean FSH levels before and 3 months after UAE were 6.83 IU/L +/- 1.8 and 6.99 IU/L +/- 1.67, respectively (P =.66). Normal menstruation resumed 2-3 months after the procedure. In two perimenopausal women, who had irregular menses and decreased ovarian reserve, mean FSH levels increased transiently from 22 and 30 IU/L to 40 and 48 IU/L, respectively, 3 months after UAE; they developed transient amenorrhea. CONCLUSION: In this study, UAE had no clinically relevant adverse effects on normally functioning ovaries and could be used safely in the treatment of symptomatic fibroids in premenopausal women. Larger studies are required for further support of this observation.     

子宫肌瘤动脉栓塞术后血流,女性激素变化及疗效的近、中期观察

目的　观察子宫肌瘤患者行动脉栓塞术后近、中期肌瘤体积 ,子宫及肌瘤血流的变化 ,临床症状的改善及女性激素水平变化的特点。方法　对 40例子宫肌瘤患者进行一次性双侧子宫动脉栓塞术术前及术后 3月、6月、9月、12月、2 4月、3 6月及 48月定期做超声测定肌瘤体积 ,子宫及肌瘤血流状态 ,定期测定血液中各类女性激素浓度 ,随访患者临床症状的变化。结果　所有患者术后各个时期随访 ,肌瘤内都未见血流信号。统计学数据表明 ,术后各期正常子宫血流与术前比较无显著差异。术后各期月经较术前明显改善 ,肌瘤显著缩小 ,与术前比较有显著差异。其中 ,术后 3～ 9月肌瘤持续缩小 ,且术后 3～ 9月之间各期肌瘤体积有显著差异 ,术后 9～48个月之间各期肌瘤大小测定无显著差异。术后各期HCG ,LH ,E2 ,FSH ,PRL ,P ,T激素水平与术前比较无差异。结论　子宫肌瘤栓塞术是一种有效的治疗手段     

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...     

子宫动脉栓塞对子宫腺肌病患者卵巢功能的影响

目的评价子宫动脉平阳霉素碘油乳剂栓塞对子宫腺肌病患者卵巢功能的影响。方法对33例子宫腺肌病患者用平阳霉素碘油乳剂进行子宫动脉栓塞,并检测栓塞前和栓塞后第1、3、6和12个月的患者以及45例正常体检女性(对照组)同期血中的雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)和催乳素(PRL)水平,其后对两组结果作比较研究。结果栓塞前33例患者的FSH、LH、E2水平与正常对照组差异无显著性(P>0.05),而PRL水平高于正常对照组(P<0.05);栓塞术后1、3、6和12个月的患者FSH、LH、E2皆与术前无显著性差异(P>0.05),但PRL水平较栓塞前明显下降(P<0.05)。结论子宫动脉平阳霉素碘乳剂栓塞治疗子宫腺肌病并不影响患者的卵巢功能,且有利于降低患者的PRL水平。     

Ovarian function after uterine artery embolization for leiomyomata: assessment with use of serum follicle stimulating hormone assay

PURPOSE: To determine if uterine artery embolization (UAE) for leiomyomata causes a change in ovarian function as measured by serial basal follicle stimulating hormone (FSH) assay. MATERIALS AND METHODS: Sixty-three patients undergoing UAE for symptomatic leiomyomata had blood samples obtained on day 3 of a menstrual cycle before UAE and on day 3 during menstrual cycles 3 and 6 months after treatment. Analysis of variance was used to detect differences in FSH levels among age groups at each interval. Repeated measures analysis of variance was used to determine if individual mean change occurred for the group as a whole and for each age group. Onset of new menopausal symptoms was compared between groups with use of the chi(2) test. RESULTS: There was no significant change in basal FSH levels for the group as a whole (P =.16), but there was a statistically significant difference when age groups were compared (P =.03). Individual change of >2 SD from baseline mean FSH level occurred at 6 months in seven patients, all 45-50 years of age. Four of these patients (15% of patients over age 44) had FSH levels increase to more than 20 IU/L. chi(2) analysis did not reveal any difference among the groups studied in the onset of menopausal symptoms. CONCLUSIONS: Most patients had no change in ovarian function as measured by basal FSH after UAE. For patients aged 45 or older, there is approximately a 15% chance of an increase in basal FSH into the perimenopausal range.     

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.     

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.     

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.     

Repeat uterine artery embolization: indications and technical findings

PURPOSE: To determine the indications and technical aspects of procedures in patients undergoing repeat uterine artery embolization (UAE). MATERIALS AND METHODS: At a single center, 24 patients underwent repeat embolization for recurrent or persistent symptoms. The magnetic resonance (MR) imaging findings before repeat embolization were compared with those of earlier studies. The extent of tumor infarction after the first procedure was determined, and the status of existing or new tumors before the second procedure was assessed. The angiographic studies from the initial and repeat embolization studies were reviewed and summarized. These findings were assessed with the use of summary statistics. RESULTS: Twenty-four patients underwent repeat embolization 6-66 months after the initial embolization. The most common symptom at representation was pressure and/or bulk symptoms (n=15), followed by recurrent heavy bleeding (n=12) and pelvic pain or cramping (n=7). MR imaging studies before repeat embolization revealed incomplete infarction of tumors present before the first embolization in 22 of 24 patients. New tumors were identified in 12 patients, two of whom had new tumors only. During repeat embolization, nine patients (37%) required ovarian artery embolization to occlude ovarian supply to the uterus. Among 21 women with clinical follow-up after the second embolization, 19 (90%) had symptom control. CONCLUSIONS: Repeat embolization prompted by recurrent uterine leiomyomas usually occurs in the setting of regrowth of incompletely infarcted tumors. Although ovarian embolization was often needed, on the basis of this limited experience, symptoms appear to respond well to repeat embolization.