三丙烯微球栓塞子宫动脉对子宫内膜血管的影响

背景：子宫动脉栓塞已广泛应用于临床治疗多种妇产科疾病,但对于子宫动脉栓塞后子宫内膜微血管密度的有何变化及新生血管的形成至今少有文献报道。 目的：观察子宫动脉栓塞对子宫内膜微血管密度及新生血管形成的影响。 方法：60只雌性豚鼠随机分为对照组(n=15)及子宫动脉栓塞组(n=45),子宫动脉栓塞组动物应用三丙烯微球行双侧子宫动脉栓塞。子宫动脉栓塞组再随机分为E1,E2及E3三个亚组(n=15),分别于子宫动脉栓塞后7-15 d,16-30 d及31-45 d内获取子宫标本。 结果与结论：常规病理染色显示豚鼠子宫动脉一级分支、浆膜下动脉支及子宫肌层微小动脉血管内均可见大小不等栓塞微球分布。子宫动脉栓塞豚鼠子宫内膜基底层微血管密度CD34在子宫动脉栓塞后降低,而后随时间的延长而增加(P < 0.05);而子宫动脉栓塞豚鼠子宫内膜基底层微血管密度CD105在子宫动脉栓塞后增加,而后随时间的延长而降低(P < 0.05)。提示随着栓塞后时间推延,新生微血管数量显著增加,基底层微血管密度有逐渐恢复趋势。     

转化生长因子β1促进大鼠子宫内膜纤维化

目的 探讨大鼠子宫内膜纤维化中转化生长因子β1(TGF-β1)的表达及相关机制。方法 将SD雌性大鼠随机分成假手术组(n=12)和模型组(n=12)。术后7、14及28 d收集双侧子宫组织，HE染色观察子宫内膜形态，动态观察子宫内膜病理改变和子宫内膜腺体数目；Masson染色检测子宫内膜纤维化程度；免疫组织化学法检测TGF-β1及α-SMA蛋白表达。结果 相比假手术组，模型组大鼠子宫结构破坏；术后7、14和28 d,子宫内膜TGF-β1蛋白表达显著升高(P<0.05);术后14和28 d,子宫内膜腺体数目明显减少、子宫内膜纤维化面积比例明显增加，α-SMA蛋白表达上调(P<0.05)。结论 TGF-β1可能通过激活肌成纤维细胞及相关信号通路进一步促进子宫内膜纤维化。     

缺氧诱导因子-1α在子宫内膜异位症患者子宫内膜的表达及意义

目的:观察分析缺氧诱导因子-1α(HIF-1α)在子宫内膜异位症(简称内异症)患者子宫内膜细胞的表达及意义。方法:收集不同r-AFS分期子宫内异症患者(内异症组,n=35)和同期子宫肌瘤患者(对照组,n=40)子宫内膜组织标本,应用免疫组织化学(SP)技术检测各组(期)HIF-1α的表达情况,分析组间差异及与r-AFS分期的相关性。结果:子宫内异症组异位、在位子宫内膜HIF-1α阳性表达率分别为82.86%和77.14%,均明显高于对照组子宫内膜(52.50%)(χ~2=7.741、4.920,P均0.05),且子宫内异症组子宫内膜HIF-1α阳性表达率随r-AFS分期提高而升高(r=0.363,P0.05)。结论:HIF-1α表达上调可能与子宫内异症的发生发展有关。     

米非司酮对大鼠异位子宫内膜细胞中BCL-2/BAX表达的影响

米非司酮因对孕激素和皮质醇受体有高度的亲和力,临床上普遍用于抗早孕药物流产、紧急避孕、催经等,而治疗子宫内膜异位症(ectop ic endom etrium,EMT)还在研究阶段。米非司酮可以诱导早孕蜕膜细胞及离体异位子宫内膜细胞凋亡[1],但对大鼠异位子宫内膜的细胞凋亡国内外均未见报道。本实验建立大鼠EMT动物模型,从基因水平探讨其治疗EMT的机制。1材料与方法1·1实验动物及模型制备:雌性SD大鼠32只,体重(200±50)g,参照文献造模[2]。3周后剖腹探查,除假手术组外,可见其余动物的移植子宫内膜均成活。1·2分组:造模成功后分为3组,假手术组(…     

实验性子宫内膜异位症动物模型研究

目的　利用大鼠子宫内膜异位症动物模型 ,探讨卵巢切除术和丹那唑治疗对大鼠子宫内膜异位症的影响。方法　将已成模大鼠随机分为 3组 :对照组 (n =2 3)、卵巢切除术组 (n =2 4)和丹那唑组 (n =2 9) ,在行双侧卵巢切除术或丹那唑治疗后的 2、4、6和 8周处死大鼠 ,同时观察移植物的生长情况。结果　卵巢切除术组和丹那唑组大鼠移植物体积均明显缩小 ,并且 4、6和 8周与 2周相比 ,作用更明显。组织学检查 ,对照组异位子宫内膜呈增生状态 ,而卵巢切除术组和丹那唑组呈萎缩状态。结论　卵巢切除术和丹那唑治疗可使大鼠异位子宫内膜逐渐萎缩退化 ,但未能使其消失 ,丹那唑的治疗作用具有时间相关性。     

基质金属蛋白酶-2、3及其组织抑制剂TIMP-1在子宫内膜异位症中的表达

目的探讨基质金属蛋白酶(MMP-2、MMP-3)及其抑制剂(TIMP-1)在子宫内膜异位症发生及发展中的作用.方法采用免疫组化SP法分别测定MMP-2、MMP-3 、TIMP-1在卵巢子宫内膜异位症异位内膜60例(A组),子宫腺肌症异位内膜40例(B组),子宫肌瘤子宫内膜30例(对照组C)的表达强度.结果 A、B组中MMP-2、MMP-3的表达强度明显高于对照组(P<0.05)而TIMP-1的表达明显低于对照组(P<0.05);A、B组间MMP-2、MMP-3 、TIMP-1 的表达无明显差异(P>0.05).结论在子宫内膜异位症中MMP-2、MMP-3的过度表达及TIMP-1的低表达可能与内异症的发生与发展有关.     

VEGF基因多态性与子宫内膜异位症和子宫腺肌病遗传易感性研究

目的 探讨血管内皮生长因子(vascular endothelial growth factor,VEGF)基因启动子区-460C/T和-1154G/A单核苷酸多态性与子宫内膜异位症和子宫腺肌病发病风险的关系.方法 采用聚合酶链反应-限制性片段长度多态方法检测344例子宫内膜异位症患者(内异症组)和360名对照妇女(对照组)、174例子宫腺肌病患者(腺肌病组)和199名对照妇女(对照组)的VEGF基因2个多态性位点的基因型频率分布情况.结果 VEGF-460C/T多态的基因型和等位基因频率分布在两病例组与其对照组间差异均无统计学意义(P>0.05).在内异症组和对照组中,VEGF-1154G/A多态的AA、GA、GG 3种基因型频率分别是1.7%、28.8%、69.5%和5.8%、32.8%、61.4%,两组比较差异有统计学意义(P=0.006);G、A等位基因频率分别是83.9%、16.1%和77.8%、22.2%,两组比较差异有统计学意义(P=0.004);与GA+AA基因型相比,携带GG基因型明显增加内异症的发病风险(OR=1.43,95%CI:1.05～1.96).在腺肌病组和对照组中,VEGF-1154G/A多态的AA、GA、GG 3种基因型频率分别是2.9%、23.6%、73.6%和7.0%、34.2%、58.8%.两组比较差异有统计学意义(P=0.007);G、A等位基因频率分别是85.3%、14.7%和75.9%、24.1%,两组比较差异有统计学意义(P=0.001);与GA+AA基因型相比,携带GG基因型明显增加腺肌病的发病风险(OR=1.95,95%CI:1.26～3.03).结论 VEGF基因启动子区-1154G/A多态与子宫内膜异位症和子宫腺肌病的发病风险明显相关,携带GG基因型显著增加子宫内膜异位症和子宫腺肌病的发病风险.     

EphA2及其配体在子宫内膜样腺癌中的表达及其与血管生成的关系

 目的： 探讨生促红素肝细胞受体A2 （EphA2）及其配体ephrin-A1在子宫内膜样腺癌组织中的表达及其与肿瘤血管生成的关系。方法： 利用免疫组织化学法检测56例子宫内膜样腺癌、20例子宫内膜增生过长、30例正常子宫内膜增殖期和30例分泌期组织中EphA2、ephrin-A1、雌激素受体（ER）和孕激素受体（PR）的表达,并采用CD34抗体标记微血管内皮细胞,计算微血管密度(MVD)。分析EphA2和ephrin-A1的表达与MVD之间的相关性及其与子宫内膜样腺癌临床病理特征的关系。结果： 子宫内膜样腺癌组织中EphA2和ephrin-A1的表达显著高于子宫内膜样增生过长及正常子宫内膜(P<0.05);EphA2和ephrin-A1表达水平及MVD值与子宫内膜样腺癌FIGO分期、肿瘤分化程度、肌层浸润深度、淋巴微血管浸润和孕激素受体表达有关(P<0.05);Spearman等级相关分析表明EphA2和ephrin-A1表达分别与MVD呈显著正相关(r=0.476,P<0.05;r=0.501,P<0.05)。结论： EphA2及其配体ephrin-A1在子宫内膜样腺癌中高表达,可能参与了肿瘤血管生成和孕激素抵抗。     

子宫内膜异位症患者血清中胰岛素样生长因子Ⅰ(IGF1)水平变化的意义

目的探索子宫内膜异位症患者血清IGF1水平变化与子宫内膜异位症发病的关系。方法采用双抗体夹心ABC ELISA法测定36例子宫内膜异位症患者及24例健康妇女IGF1水平。结果(1)子宫内膜异位症组血清IGF1水平为(284.4±86.6)ng/m l,对照组血清IGF1水平为(138.2±74.1)ng/m l。子宫内膜异位症组血清IGF1水平高于对照组血清IGF1水平,两组比较,差异有显着性(P<0.05)。(2)两组妇女分别进行增生期与分泌期血清中IGF1水平比较,正常组妇女增生期与分泌期血清中IGF1水平比较,差异无显著性(P>0.05)。子宫内膜异位症组妇女增生期与分泌期血清中IGF1水平比较,差异无显着性(P>0.05)。结论血清中IGF1水平变化与子宫内膜异位症的发病密切相关。     

阿司匹林在宫腔镜宫腔粘连分离术后子宫内膜修复综合治疗中的应用

目的:探讨阿司匹林在宫腔镜宫腔粘连分离术后子宫内膜修复综合治疗中的应用价值.方法:将2020年5月-2021年5月在我院接受宫腔镜宫腔粘连分离术后子宫内膜修复综合治疗的患者98例按照随机数字表法分为两组,其中对照组49例给予补佳乐治疗,观察组49例在此基础上联合阿司匹林治疗.观察两组术后3个月的治疗效果,对比两组子宫内膜厚度及子宫内膜类型,测量两组子宫动脉血流阻力指数(RI)及子宫动脉搏动指数(PI),随访术后3个月的妊娠情况,记录两组不良反应发生率.结果:对照组治疗总有效率(71.43％)低于观察组(87.76％),差异有统计学意义(P<0.05).对照组子宫内膜厚度低于观察组,差异有统计学意义(P<0.05);观察组子宫内膜A型少于对照组,差异有统计学意义(P<0.05).观察组PI及RI值均低于对照组,差异有统计学意义(P<0.05).两组不良反应发生率对比,差异无统计学意义(χ2=0.380,P>0.05).结论:阿司匹林应用于宫腔镜宫腔粘连分离术后子宫内膜修复综合治疗中效果较佳,可有效促进子宫内膜修复,改善子宫内膜的受容性,安全有效.     

剖宫产瘢痕妊娠病灶切除术与子宫动脉栓塞术后 清宫的效果比较

目的 比较剖宫产瘢痕妊娠病（CSP）灶切除与子宫动脉栓塞后清宫的临床效果。方法 回顾性分析2015年1月~2018年6月我院收治的110例剖宫产瘢痕妊娠患者的临床资料,根据手术方式分为手术组（52例）和清宫组（58例）,手术组行瘢痕病灶切除术,清宫组同期行子宫动脉栓塞后清宫,比较两组术中出血量、血HCG下降至正常的时间、住院费用及术后第1次月经量改变情况。结果 手术组平均出血量为（80.59±17.12）ml,高于清宫组的（8.65±1.53）ml,差异有统计学意义（P＜0.05）;手术组血HCG下降至正常时间为（22.40±7.45）d,少于清宫组的（31.80±8.24）d,差异有统计学意义（P＜0.05）;两组住院费用比较,差异无统计学意义（P＞0.05）;清宫组有9例出现术后第1次月经量减少,手术组无患者发生月经量改变。结论 瘢痕妊娠病灶切除与子宫动脉栓塞后清宫的住院费用相当,但子宫动脉栓塞后清宫有瘢痕持续存在、术后血HCG下降缓慢、部分患者出现月经量减少的缺点,故对于肌壁厚度＜4 mm,有再生育要求的CSP患者,瘢痕病灶切除术应作为首选的治疗措施。     

CalliSpheres载药微球子宫动脉栓塞术治疗宫颈癌的疗效评价

目的　评价CalliSpheres载药微球子宫动脉栓塞术治疗局部晚期宫颈癌疗效。 方法　选取2016年2月至2018年9月本介入科收治的宫颈癌患者48例（平均年龄49岁）,采用随机数字分配法将患者分为普通微球子宫动脉栓塞+表阿霉素子宫动脉灌注化疗组24例（A组）,表阿霉素载药微球子宫动脉栓塞化疗组24例（B组）。每组治疗2个周期,间隔3周。记录出血减少情况,以CT评价肿瘤大小变化,分析骨髓抑制及消化道反应。 结果　（1）两组患者阴道出血均减少;普通微球组术后出血持续时间为（6±1.5）d,载药微球组为（3± 0.8）d,差异有统计学意义,P<0.01。（2）肿瘤缩小率：普通微球组客观缓解率为83.8%,载药微球组为95.8%,差异有统计学意义,P<0.01。（3）副反应：两组患者均出现腹痛,VAS评分普通微球组（8±2）分,载药微球组（3±1）分,差异有统计学意义,P<0.01;骨髓抑制仅发生于普通微球组。 结论　CalliSpheres载药微球治疗宫颈癌较传统的化疗栓塞术具有更高的肿瘤缩小率,术后阴道出血时间更短,无骨髓抑制且腹痛可控。     

Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy

BACKGROUND: Ovarian failure as a complication of uterine artery embolization (UAE) for symptomatic uterine fibroids has raised concerns about this new treatment modality. METHODS: We investigated the occurrence of ovarian reserve reduction in a randomized trial comparing UAE and hysterectomy by measuring follicle stimulating hormone (FSH) and anti-Mullerian hormone (AMH). A total of 177 pre-menopausal women with menorrhagia due to uterine fibroids were included (UAE:n=88; hysterectomy:n=89). FSH and AMH were measured at baseline and at several time-points during the 24 months follow-up period. Follow-up AMH levels were also compared to the expected decrease due to ovarian ageing during the observational period. RESULTS: FSH increased significantly compared to baseline in both groups after 24 months follow-up (within group analysis: UAE:+12.1; P=0.001; hysterectomy:+16.3; P<0.0001). No differences in FSH values between the groups were found (P=0.32). At 24 months after treatment the number of patients with FSH levels>40 IU/l was 14/80 in the UAE group and 17/73 in the hysterectomy group (relative risk=0.75; P=0.37). AMH was measured in 63 patients (UAE: n=30; hysterectomy: n=33). After treatment AMH levels remained significantly decreased during the entire follow-up period only in the UAE group compared to the expected AMH decrease due to ageing. No differences were observed between the groups. CONCLUSIONS: This study shows that both UAE and hysterectomy affect ovarian reserve. This results in older women becoming menopausal after the intervention. Therefore, the application of UAE in women who still wish to conceive should only be considered after appropriate counselling.     

子宫动脉栓塞术联合宫腔镜治疗 子宫黏膜下大肌瘤的效果

目的 探讨子宫黏膜下大肌瘤实施子宫动脉栓塞联合宫腔镜治疗的临床效果。方法 选择我院2017年1月~2018年7月收治的60例子宫黏膜下大肌瘤患者,随机分为宫腔镜组和联合组,各30例。宫腔镜组患者运用宫腔镜电切治疗,联合组在此基础上联合子宫动脉栓塞治疗,比较两组宫腔镜手术时间、术中出血量、术后排气时间、治疗总有效率、术后并发症情况及术后3个月血红蛋白、月经量、月经时间变化情况。结果 联合组宫腔镜手术时间、术中出血量、术后排气时间及术后并发症发生率分别为（52.23±5.67）min、（32.29±5.38）ml、（12.83±2.18）h、6.67%,均低于宫腔镜组的（72.44±6.54）min、（75.46±4.53）ml、（22.15±4.23）h、26.67%,差异有统计学意义（P＜0.05）;联合组治疗总有效率为96.67%,高于宫腔镜组的80.00%,差异有统计学意义（P＜0.05）;联合组术后3个月血红蛋白水平高于宫腔镜组,差异有统计学意义（P＜0.05）;联合组月经量、月经时间低于宫腔镜组,差异有统计学意义（P＜0.05）。结论 子宫黏膜下大肌瘤实施子宫动脉栓塞联合宫腔镜治疗效果好,且可有效减轻手术创伤,降低术后并发症风险,促进患者术后恢复。     

Management of Bleeding Uterine Arteriovenous Malformation with Bilateral Uterine Artery Embolization

Purpose

To evaluate the technical feasibility and clinical outcome of bilateral uterine artery embolization (UAE) as a first-line therapeutic option for bleeding uterine arteriovenous malformation (AVM).

Materials and Methods

Between 2002 and 2012, 19 patients were diagnosed with acquired uterine AVM clinically and through imaging studies. The clinical characteristics, angiographic features, technical success rate of embolization, procedure-related complications, imaging, and clinical follow-up data were assessed. Clinical success was defined as immediate symptomatic resolution with disappearance of vascular abnormality on subsequent imaging studies.

Results

A total of 20 bilateral UAE, with or without embolization of extra-uterine feeders, were performed as the first-line treatment. Technical and clinical success rate was 90.0% (18/20) and 89.5% (17/19), respectively. Embolization was incomplete in two patients who had residual extra-uterine fine feeders to the AVM or a procedure-related complication (ruptured uterine artery); the former showed slow regression of the vascular malformation during the observation period, while the latter underwent a successful second bilateral UAE. Immediate clinical success was achieved in the remaining 17 patients after a single session and no recurrence of bleeding was found. Recovery to normal menstrual cycle was seen in all 17 patients with clinical success within one or two months, two of whom subsequently had uneventful intrauterine pregnancies carried to term.

Conclusion

Bilateral UAE is a safe and effective first-line therapeutic option for the management of bleeding uterine AVMs. However, incomplete embolization due to unembolizable feeders or difficult access into the uterine artery may lead to suboptimal treatment.     

Non-surgical management of uterine fibroids

BACKGROUND: Efforts to develop alternatives to surgery for managementof symptomatic uterine fibroids have provided new techniquesand new medications. This review summarizes the existing literatureon uterine artery embolization (UAE) and investigational studieson four newer approaches. METHODS: PubMed, Cochrane and Embasewere searched up to December 2007. Studies reporting side-effectsand complications and presenting numerical data on at leastone outcome measure were included. RESULTS: Case studies report50–60% reduction in fibroid size and 85–95% reliefof symptoms following UAE. The largest of these studies reportedan in-hospital complication rate of 2.7% (90 of 3041 patients)and a post-discharge complication rate of 26% (710 of 2729 patients).Eight studies compared UAE with conventional surgery. Best evidencesuggested that UAE offered shorter hospital stays (1–2days UAE versus 5–5.8 days surgery, 3 randomized controlledtrials (RCTs)) and recovery times (9.5–28 days UAE versus36.2–63 days surgery, 3 RCTs) and similar major complicationrates (2–15% UAE versus 2.7–20% surgery, 3 RCTs).Four studies analysing cost-effectiveness found UAE more cost-effectivethan surgery. There is insufficient evidence regarding fertilityand pregnancy outcome after UAE. Five feasibility studies aftertransvaginal temporary uterine artery occlusion in 75 womenshowed a 40–50% reduction in fibroid volume and two earlystudies using magnetic resonance guided–focused ultrasoundshowed symptom relief at 6 months in 71% of 109 women. Two smallRCTs assessing mifepristone and asoprisnil showed promisingresults. CONCLUSIONS: Good quality evidence supports the safetyand effectiveness of UAE for women with symptomatic fibroids.The current available data are insufficient to routinely offerUAE to women who wish to preserve or enhance their fertility.Newer treatments are still investigational.     

Leiomyosarcoma with dedifferentiation in a premenopausal patient discovered after uterine artery embolization

Although a hysterectomy is the most common treatment for relieving the symptoms attributable to uterine leiomyomas, uterine artery embolization (UAE) is now being used more frequently as an alternative to a hysterectomy. However, it is difficult to differentiate a leiomyoma from a leiomyosarcoma without performing a pathological examination. Reported herein is a rare case of leiomyosarcoma that showed dedifferentiation of the tumor cells after UAE. A premenopausal 48-year-old woman had been suffering from hypermenorrhea for 4 years before visiting the clinic. She underwent UAE for suspected symptomatic leiomyoma. Two months later, dilatation and curettage was performed because of genital bleeding and a necrotic mass was submitted for pathological examination. Three months after curettage, with renewed symptoms, endometrial biopsy was done, which confirmed pleomorphic sarcoma. Metastatic nodes to the lung were also found at that time. Multiple leiomyosarcomas and a leiomyosarcoma showing dedifferentiation of the uterine body were found on pathological examination. The patient had metastatic nodes to the brain later and died of metastatic disease 20 months in total after UAE. This is a rare case of leiomyosarcoma with dedifferentiation and multiple metastases occurring after UAE, suggesting that dedifferentiation could be derived from ordinary leiomyosarcoma and that the traumatic effect of curettage might cause early metastasis. The present case is a warning that careful and detailed evaluation of the uterine tumor are needed before UEA.     

腹腔镜下电凝阻断子宫动脉在无生育要求患者子宫肌瘤剔除术中的应用及预后

目的 探讨腹腔镜下电凝阻断子宫动脉在子宫肌瘤剔除术中的应用及预后。方法 对2009年2月~2011年2月来我院因子宫肌瘤行肌瘤剥除手术治疗的住院患者共83例,按照随机数字表法将患者分为实验组和对照组,实验组41例先行腹腔镜下子宫动脉电凝阻断再行肌瘤剥除术,对照组42例直接行腹腔镜下子宫肌瘤剥除术,比较两组的手术时间、术中出血量、肛门排气时间、住院时间、并发症发生率。2年内对所有患者定期随访,观察月经量,B超复查监测肌瘤复发情况。结果 与对照组比较,实验组手术时间缩短（109.92±17.52）min vs（84.83±8.63）min,术中出血量减少（163.13±36.42）ml vs（94.42±13.73）ml,差异有统计学意义（P＜0.05）;两组患者的肛门排气时间（29.64±2.44）h vs（28.84±2.94）h、住院时间（6.53±0.63）d vs（6.23±0.92）d、并发症发生率7.10% vs 7.30%比较,差异无统计学意义（P＞0.05）。随访2年,实验组月经量少于对照组（60.53±17.62）ml vs（133.82±32.53）ml,差异有统计学意义（P＜0.05）。实验组肌瘤无1例复发,对照组子宫肌瘤有6例复发,实验组复发率（0%）优于对照组（14.30%）,差异有统计学意义（P＜0.05）。结论 腹腔镜下电凝阻断子宫动脉后再行肌瘤剥除术可有效的减少术中出血量,缩短手术时间,减少术后月经量,降低肌瘤复发率。     

Uterine artery embolisation for symptomatic fibroids: the University of Malaya Medical Centre experience

Background:

Transcatheter uterine artery embolisation (UAE) for the treatment of symptomatic fibroids has been performed in several centres in the United States, Western Europe and Asia with promising results. This study reports the authors'' experience with UAE at the University Malaya Medical Centre.

Method:

Fifty women with symptomatic uterine fibroids who declined surgery were treated by transcatheter UAE. The uterine arteries were selectively catheterised and embolised with polyvinyl alcohol particles. Post-procedure analgesia was administered via patient-controlled analgesic pump. The patients were followed up at an interval of 6/12 clinically and with MRI.

Results:

Transcatheter UAE was performed on all 50 patients with no major complications. 49 patients had both uterine arteries embolised while 1 patient had only the right uterine artery embolised on account of hypoplasia of the left uterine artery due to previous myomectomy. The mean hospital stay was 3.5 days (range, 2 to 7). At a mean follow-up of 24/52, all patients reported improvements in their presenting symptoms. Objective improvement in terms of reduction of uterine and fibroid sizes was determined on MRI. One patient, who initially responded with a decrease in uterine and dominant fibroid size, became symptomatic (menorrhagia) after 6 months and subsequent endometrial sampling revealed cystic glandular hyperplasia for which total abdominal hysterectomy was performed. Two other patients had no change in symptoms and after hysterectomy, the pathology revealed concurrent adenomyosis. Another 2 patients with cervical fibroids were treated with hysterectomy as there was no gross reduction in the size of fibroid following UAE. Overall, 90% of the patients had dramatic improvement of anaemia and symptoms at 1 year follow-up.

Conclusion:

Out of the 50 patients, 17 patients had total disappearance of their fibroids and 28 patients had more than 50% reduction in the size of fibroids after 1 year. 5 patients ended up with total abdominal hysterectomy. These results suggest that UAE is an appealing alternative to hysterectomy or myomectomy for many women with symptomatic fibroids.