经导管子宫动脉栓塞术治疗子宫肌瘤的临床观察

目的 探讨经导管子宫动脉栓塞（TUAE）治疗子宫肌瘤的疗效及安全性。方法 对38例子宫肌瘤患者经导管子宫动脉注射碘油－平阳霉素乳剂行TUAE治疗,其中5例于栓塞后1－3周行全子宫切除或肌瘤剔除术,标本送病理检查;对33例随访6－12个月者,观察肌瘤与子宫体积变化及卵巢内分泌功能改变。结果 行TUAE后,患者总的症状改善率为90．6％（29／32）,其中月经完全恢复正常为90．3％（28／31）,下腹部、腰腿胀痛消失为83．3％（25／30）,尿频、尿急等压迫症状消失为45．5％（5／11）。栓塞6个月后,肌瘤与子宫体积平均缩小为59．1％和49．3％,栓塞12个月后平均缩小为61．8％和49．9％。卵巢内分泌功能栓塞前后无显著变化。手术标本病理学检查,碘油仅分布于肌瘤组织,栓塞2周后肌瘤组织出现点状坏死,3周后出现大量片状坏死,而正常子宫肌组织未见异常。结论 行TAUE治疗子宫肌瘤,近期疗效明显,对卵巢内分泌功能及正常子宫肌组织无明显影响。

Clinical observation of transcatheter uterine artery embolization for uterine myoma

OBJECTIVE: To investigate the efficiency and safety of transcatheter uterine artery embolization (TUAE) for uterine myomas. METHODS: Thirty-eight cases of uterine myomas were treated by TUAE using lipiodol-pingyangmycin emulsion. 5 of 38 cases underwent hysterectomy or myomectomy from 1 to 3 weeks after TUAE. The specimens were studied pathologically. Thirty-three of 38 patients were followed for 3 to 6 months to observe the changes of myoma size and uterine volume and overian function. RESULTS: Symptom released in 90.6% (29/32), that was controlled of menorrhagia in 90.3% (28/31), disappeared of lumbago and lower abdominal pain in 83.3% (25/30), relieved of freguency and urgency of micturition in 45.5% (5/11). The mean reduction of myoma and uterine volume at 6 months was 59.1% and 49.3%, respectively, and at 12 months was 61.8% and 49.9% respectively. There was no significant difference in hormone level pre-embolization and post-embolization. Pathological studies of specimens showed that lipiodol deposition was found in myomas but not in myometrium. Myomas occurred spotty necrosis 2 weeks after embolization and extensive patchy necrosis 3 weeks after embolization. Degeneration or necrosis were not seen in myometrium. CONCLUSIONS: TUAE possesses a good effect for uterine myomas and doesn't result in the damage of ovarian hormone secretion and the myometrium.