超声引导下注射氨甲喋呤治疗子宫肌瘤的初步研究

目的:观察超声引导下经阴道向瘤体内注射氨甲喋呤(MTX)治疗子宫肌瘤的效果。方法:对30例子宫肌瘤患者采用超声引导下经阴道瘤体内注射MTX,剂量50~60mg,每月1次,连续注射3个月,定期复查B超,观察肌瘤大小的变化;彩超下观察注药前后肌瘤血供情况变化。其中2例患者在注药1个月后接受手术治疗,切除的肌瘤标本行光镜和电镜下组织观察分析并与未注药的肌瘤标本(对照组)相比较。结果:28例子宫肌瘤患者治疗前体积为(59·21±21·76)cm3,注药1个月后体积为(48·67±25·87)cm3,与治疗前相比无明显差异(P>0·05);第2次注药1个月后肌瘤体积为(41·43±27·01)cm3;第3次注药1个月后肌瘤体积为(32·20±19·71)cm3,与治疗前相比,均有显著差异(P<0·05);注药半年后的肌瘤体积为(30·51±17·37)cm3,与注药3个月时的体积相比较无明显差异(P>0·05)。彩超下显示注药后的肌瘤组织内部血流信号减弱,血供明显减少。治疗后3个月时肌瘤血供与治疗前相比,有显著差异(P<0·05);半年后肌瘤内血流信号与治疗前相比,仍有显著差异(P<0·05)。光镜下可见注药后的肌瘤活检切片单位视野内的平均血管数较对照组明显减少,管腔变窄,肌瘤细胞水肿及变性;电镜下可见细胞内质网及线粒体有明显的水肿及变性。结论:超声引导下经阴道瘤内注射MTX治疗子宫肌瘤疗效确切,近期效果满意,操作简单,副作用小。

Initial Study on Injecting MTX Under Guidance of Ultrasonic Wave to Treat Uterus Myoma

Objective: To observe the treating effect of myoma of uterus by injecting MTX through vaginal under the guidance of ultrasonic wave. Method: Among 30 sufferers of uterus myoma, choosing 28 cases (two had been operated after one month since first injection), injecting MTX of 50～60mg each, once a month for three months, counterchecking by ultrasonic wave periodically, observing the changes of myoma size, and observing the changes of blood supply in myoma.Results: The sizes of 28 myoma before treatment had been (59.21±21.76)cm~3,which became (48.67±25.87)cm~3 a month after first injection(P>0.05), (41.43±27.01)cm~3 a month after second injection, and (32.20±19.71)cm~3 a month after third injection(P<0.05). It was definitely different from that before treatment. Half a year after first injection, it becomes (30.51±17.37)cm~3. Conclusion: Treating myoma by injection MTX has not only firm, curative and satisfactory effect, but can be simply operated with little side-effect.