肝动脉栓塞治疗肝海绵状血管瘤的疗效评价（附21例报告）

目的 :评价平阳霉素碘化油乳剂 (PLE)与无水乙醇 碘化油乳剂 (ELE)经肝动脉栓塞治疗肝海绵状血管瘤 (CHL)的疗效并进行比较。材料和方法 :回顾性分析经肝动脉栓塞治疗 2 1例肝脏海绵状血管瘤 ,15例肝动脉注入PLE ,6例肝动脉注入ELE ,观察其栓塞前后肿瘤大小变化、临床症状的缓解和并发症发生情况。结果 :PLE与ELE栓塞后肝海绵状血管瘤均有明显缩小 ,临床症状缓解 ,术后 6个月随访观察 ,肿瘤最大直径分别由术前 7.5 7± 3 .91cm、7.5 0± 1.5 9cm缩小为 4.3 3± 0 .80cm、3 .72± 0 .45cm ,有显著性差异 (P <0 .0 5 ) ,但PLE栓塞术后并发症明显较ELE要轻。结论 :介入栓塞治疗CHL疗效肯定 ,PLE肝动脉栓塞治疗CHL的安全性优于ELE。     

介入治疗肝海绵状血管瘤平阳霉素碘油乳剂用量的探讨

目的探讨介入治疗肝海绵状血管瘤的栓塞剂用量。方法超选择性肝动脉插管平阳霉素碘化油乳剂(PLE)栓塞治疗肝海绵状血管瘤40例,根据栓后瘤周有无碘油进入分为2组。对比观察2组药物用量、疗效、并发症。结果2组有效率无显著差异,药物用量、持续性疼痛发生率碘油进入门静脉组均高于对照组。结论CHL栓塞治疗中,栓塞剂用量应以个体化原则,以不出现瘤周门静脉碘油进入为宜。     

肝海绵状血管瘤血供和介入治疗的争议和探讨

目的 进一步探讨成人肝海绵状血管瘤(cavemous hemangiomas of the liver，CHL)的血供和介入治疗。方法 近来有人报道少数门静脉供血的CHL病例通过门静脉插管栓塞治疗取得满意的疗效，并对通常认为的CHL血供完全来自肝动脉的观点提出了质疑。为求得一科学合理的解释，作者复习了肝脏的血管胚胎发生学和组织学、CHL的病理改变以及相关的文献，并结合2000～2002年曾作过的CHL血液动力学研究结果作进一步探讨。结果 CHL系肝脏血窦于胚胎阶段的发育障碍所致。病理学上，GHL是由多数扩张的异常血窦构成，窦腔大小不一，且与CHL的血液动力学变化密切相关(呈反比例关系)。病理所示的均一细小异常血窦(直径小于50μm)所构成的CHL常显示为高流量。于肝动脉造影或经肝动脉注入对比剂CT增强扫描(CTHA)时，瘤体可快速地被含对比剂的动脉血液充盈，经常呈浓密的显影或增强，同时并可引起异常血窦腔内压增加；当其内压超过与其相连接的门静脉小支内压时，充盈于异常血窦内的含对比剂动脉血液即可逆流入这些门静脉小支，也即肝动脉一门静脉短路(APVS)。上述表现也可见于一些中等流量的CHL，病理证实这些瘤体周边有许多细小的异常血窦。反之，病理所示的大径异常血窦(直径大于500μm)所构成的CHL常显示为低流量。于肝动脉造影或CTHA时，瘤体非常缓慢地被含对比剂的动脉血液充盈，难以显影或增强，同时也导致一低的异常血窦腔内压；当其内压低于与其相连接的门静脉小支内压时，于直接或间接门脉造影[或经脾动脉注入对比剂CT增强扫描(CTAP)]时含对比剂的门静脉血液即能很容易流入异常血窦，并使其显影或增强。结论 CHL实属一种先天性静脉畸形。所有高流量的CHL和部分中等流量的CHL都确实是肝动脉供血，并主要通过门静脉周围支引流。但是，于少数显著低流量的CHL，门静脉可以成为其主要供血血管，因此常常必须行直接或间接门脉造影(或CTAP)始能明确诊断。由此，对于CHL的经导管栓塞技术，如目的、适应证、入路和所用的硬化剂或栓塞剂等，也应重新审议，以提高其疗效。     

海藻酸钠微球联合碘化油平阳霉素乳剂在肝海绵状血管瘤栓塞术中的临床应用

目的进一步减轻肝海绵状血管瘤（cavernous hemangioma of liver,CHL）血管介入栓塞治疗的不良反应,寻找效果更好的栓塞剂。方法将60例CHL患者随机平均分为3组,每组20例。（1）SAM＋PLE组：海藻酸钠微球（sodium alginate microsphere,SAM）＋碘化油平阳霉素乳剂（pingyangmycin lipiodol emulsion,PLE）;（2）PLE组;（3）SAM组。分别行血管栓塞术,术后常规对症处理,包括止痛、保肝治疗、抗炎处理。分别对3组患者术前、术后7d肝功能,术中术后不适反应,术后3个月CT复查肿瘤的改变情况以及术后3个月临床症状缓情况进行比较。结果3组栓塞剂对肝功能的影响以PLE组最大;在术中、术后出现不适反应以SAM组最多;3组栓塞剂对于CHL治疗疗效无明显差异。结论SAM＋PLE乳剂为安全有效的栓塞剂,使用方便,对肝功能影响少,术中术后反应轻,建议在肝海绵状血管瘤的栓塞中推广使用。     

肝海绵状血管瘤CT“血池匹配”临床意义

目的探讨肝脏海绵状血管瘤(cavernous hemangioma of liver,CHL)CT多期动态增强扫描中瘤体各期强化密度与血池(腹主动脉、门静脉及肝静脉)密度匹配的诊断价值。方法经炫速双源CT多期动态增强扫描,并经手术、病理(12例)或随访2年以上(43例)证实的肝血管瘤55例共60个瘤体进行总结分析。结果按瘤体最大横径﹤15mm、15~50mm、﹥50mm将60个瘤体分为小(16个)、中(35个)、大(9个)三种。目测平扫CHL密度除少数有钙化、脂肪变、出血、血栓及纤维化引起的高或低密度区外,都与血池密度匹配。目测60个CHL的动脉期仅部分强化灶与腹主动脉匹配,而且瘤体越大,匹配的强化灶越少;门脉期强化密度都与门静脉匹配,但有少数大的瘤体内的少数强化密度停留在动脉期密度;延迟期瘤体强化密度皆与血池密度匹配。结论肝血管瘤CT"血池匹配"现象反映了CHL由大小不等血管腔(血窦)组成,并由肝动脉、门静脉共同承担血供的病理特性,对肝血管瘤的CT诊断有重要价值。     

肝海绵状血管瘤的动脉造影分型

目的 探讨肝海绵状血管瘤(CHL)动脉造影表现分型及其临床意义.资料与方法 102例CHL患者,男35例,女67例,年龄23～70岁,平均41.3岁.所有患者行肝动脉造影:导管位于肝固有动脉水平,对比剂注射流率5 ml/s,DSA连续完整采集动脉期、实质期图像.按照下述标准将动脉造影表现分为4型:富血型(Ⅰ型),乏血型(Ⅱ型),动静脉分流(AVS)型(Ⅲ型),门静脉供血型(Ⅳ型).各型判定标准:富血型为供血动脉轻-中度增粗,动脉期可见较多异常血窦显影,实质期异常血窦充盈瘤体大部分区域.乏血型为供血动脉无增粗,动脉期可见数量不多的异常血窦在瘤体周边显影,实质期异常血窦充盈瘤体小部分区域.出现AVS则不论富、乏血与否直接判定为AVS型.门静脉供血型则为动脉期及实质期完全无瘤体染色,直接或回流性门静脉造影显示异常血窦充盈染色.分型确定后对Ⅰ～Ⅲ型患者行平阳霉素碘油乳剂(PLE)肝动脉栓塞.统计总体瘤体缩小率和各型瘤体缩小率并分析其差别.结果 102例动脉造影全部成功.其中,富血型58例(56.8%),乏血型30例(29.4%),AVS型13例(12.7%),门静脉供血型1例(0.98%).在AVS型患者中,肝动脉-门静脉分流11例,肝动脉-肝静脉分流2例.分流时相出现于动脉期10例,出现于实质期3例.总体瘤体缩小率为46.7%,富血型瘤体缩小率为56.3%,而乏血型为27.9%,AVS型46.6%.各型之间瘤体缩小率差异有统计学意义(P＜0.05),而富血型和AVS型均较乏血型为高,差异有统计学意义(P＜0.05),但富血型和AVS型之间差异无统计学意义(P＞0.05).结论根据肝动脉造影表现可将CHL分为富血、乏血、AVS、门静脉供血四种类型.其中富血、乏血及AVS型之间行PLE肝动脉栓塞时瘤体缩小率有显著差别.此分型可作为选择疗法和估计瘤体缩小程度的依据.     

肝海绵状血管瘤的研究进展——图例式阐述

肝海绵状血管瘤(cavernous hemangioma of the liver,CHL)从胚胎发生学和组织病理学上均已确认其并非肿瘤,而是源自肝脏血窦胚胎发育障碍所致的先天性肝脏血管畸形。本文旨在从CHL的血供和血流动力学、影像学表现、临床分型和介入治疗方面进行论述,并配以例证/插图,以使读者对CHL有一全面的新认识。     

肝转移瘤血供对肝动脉化疗栓塞的近期疗效影响

目的 探讨肝转移瘤的血供对肝动脉化疗栓塞(TACE)疗效的影响.方法 回顾性选取经TACE治疗的肝转移瘤58例,观察临床疗效.结果 58例肝转移瘤根据DSA造影表现分为多血供型、中等血供型及少血供型,多血供型14例中有效者(CR + PR)13例(92.9%),中等血供型12例中有效者(CR + PR)10例(83.3%),少血供型32例中有效者(CR + PR)3例(9.4%).多血供型与少血供型组间、中等血供型与少血供型组间疗效差异有统计学意义(P < 0.05),而多血供型与中等血供型组间疗效差别不明显(P > 0.05).从TACE治疗开始,全部病例0.5、1年生存率分别为67.2%、42.3%,多血供型者0.5、1年的生存率分别为100%、78.6%,中等血供型者分别为100%、58.3%,少血供型者分别为40.6%、7.6%.多血供型与少血供型组间、中等血供型与少血供型组间生存期差异有统计学意义(P < 0.05),而多血供型与中等血供型组间生存期没有显著性差异(P > 0.05).结论 肝TACE对血供丰富的肝转移瘤疗效较好,区分肿瘤血供有利于治疗计划的制定.     

平阳霉素碘油乳剂动脉栓塞治疗肝血管瘤的中远期疗效评价

目的评价平阳霉素碘油乳剂(PLE)经动脉栓塞治疗肝血管瘤的中远期疗效。方法 2000年4月至2010年9月在沈阳中国医科大学第一附属医院116例肝血管瘤患者接受经动脉PLE栓塞治疗,术后进行定期随访。参照WHO实体瘤疗效评价通用标准,根据肿瘤的缩小率评价其临床疗效,同时观察临床症状的改善和并发症情况。结果对116例患者的139个病灶成功实施了栓塞治疗。随访6个月～10年,87例术前有临床症状的患者79例症状完全消失,6例缓解,2例无变化,有效率97.7%。术后复查病灶有不同程度的缩小,术后6个月～1年,1～3年,3～5年,5～10年的有效率分别为84.2%、85.4%、88.1%、96.4%。长期随访的28个病灶术后6个月～1年、1～3年、3～5年、5～10年瘤体的最大截面积分别为(30.54±23.98)cm2,(24.89±19.48)cm2,(20.73±17.78)cm2,(17.30±15.21)cm2,分别与术前[89.44±67.93)cm2]相比,差异均有统计学意义(P<0.05)。所有病例均未出现严重的并发症。结论PLE经动脉栓塞治疗安全、有效、适应证广、并发症少,是治疗肝血管瘤的理想方法。     

碘油平阳霉素乳化剂栓塞治疗肝脏海绵状血管瘤的体会

肝海绵状血管瘤(Cavernous hemangioma of Liver,CHL)是常见病,发病率为4%～7%[1],其中50%～70%无临床症状[2],当CHL较大或靠近肝表面时,会出现压迫症状,甚至破裂出血.近年来已有CHL介入治疗的文章报道,但其中远期疗效观察报道较少.笔者选择性插管注入平阳霉素、碘化油乳剂治疗肝血管瘤20例跟踪随访3～52个月.现报告如下.     

Transcatheter arterial chemoembolization in patients with hepatocellular carcinoma and coexisting hepatic cavernous hemangioma

We investigated the consequence of repeated transcatheter arterial chemoembolization (TACE) for coexisting small hepatic hemangioma in the treatment of patients with hepatocellular carcinomas and describe the imaging features of embolized hemangioma on the follow-up Lipiodol CT and MR. Six of 431 patients with biopsy-confirmed hepatocellular carcinomas, who underwent TACE, also had seven small hepatic cavernous hemangiomas (0.8∼2.3 cm) in the same area of embolization. All six patients underwent repeated TACE All lesions were evaluated with CT and/or MR for the post-treatment follow-up. The outcomes and imaging features of these embolized hemangiomas were reviewed for the change of tumor size, Lipiodol deposition, enhancing pattern as well as embolization complications. Six of the seven hemangiomas did not depict changes in the size or enhancement pattern without being ablated. One hemangioma showed a decrease in size, but still persisted after TACE. All of the hemangiomas showed Lipiodol deposition for 2∼15 months, in which five hemangiomas depicted irregular rim patterns. There is no complication caused by the procedures. The differentiation of small hepatic hemangiomas from viable HCC is important in the post-TACE follow-up to avoid unnecessary repeated embolization.     

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     

Forcible Intraarterial Injection of a Nonadhesive Liquid Embolic Agent under Microballoon Occlusion: Experimental Study in Swine Liver

PurposeTo evaluate the feasibility and effectiveness of transcatheter embolization by forcible intraarterial injection of a mixture of ethylene vinyl alcohol copolymer (EVAL) and ethanol under microballoon occlusion compared with conventional transcatheter arterial embolization methods in nontumoral swine liver.Materials and MethodsNine swine were divided into three groups: embolization with EVAL/ethanol mixture (EVAL group, n = 5), with ethiodized oil (ethiodized oil group, n = 2), and with microspheres (microspheres group, n = 2). Embolization was performed at the subsegmental hepatic artery. The EVAL/ethanol mixture was injected forcibly through a microcatheter with a balloon, which was inflated to prevent backflow of the mixture during the injection. Ethiodized oil or microspheres were injected into the artery using a microcatheter without balloon occlusion. Two animals of the EVAL group were euthanized immediately after embolization, and the distribution of EVAL was assessed microscopically. The remaining seven animals were euthanized 4 weeks after embolization, and the histopathologic changes were assessed.ResultsAll procedures were technically successful. EVAL occupied > 80% of the hepatic arterial, portal venous, and sinusoidal lumens after embolization. Ischemic coagulation necrosis was observed 4 weeks after embolization in the EVAL group. Parenchymal necrosis was not observed in the ethiodized oil and microspheres groups.ConclusionsTranscatheter embolization by forcible intraarterial injection of an EVAL/ethanol mixture under microballoon occlusion was feasible and achieved the simultaneous embolization of hepatic artery, portal vein, and sinusoids in swine liver, resulting in complete necrosis of the segment that received embolization.     

射频消融联合肝动脉栓塞治疗巨大肝血管瘤的效果评价

目的探讨射频消融（RFA）联合肝动脉栓塞（TAE）治疗巨大肝血管瘤（直径≥10 cm）的可行性、安全性及有效性。 方法收集我院2007年10月—2015年5月期间,经TAE序贯RFA治疗15例患者15个巨大肝血管瘤的临床资料。回顾性分析其一般资料、RFA治疗策略、消融相关并发症、完全消融率、消融灶直径变化及复发情况等。 结果所有患者均成功完成RFA联合TAE治疗。TAE后血管瘤的平均直径从（13.0±2.2）cm缩小至（7.1±2.0）cm。RFA治疗后,14个血管瘤（93.3%）获得完全消融。RFA治疗后1个月,消融灶平均直径缩小至（6.1±2.0）cm;6个月后缩小至（4.9±1.6）cm。15例患者中,4例患者发生了6个消融相关并发症;根据Dindo–Clavien分级,均属轻微并发症（I级）。 结论RFA联合TAE治疗巨大肝血管瘤是安全、有效的;TAE可有效阻断血管瘤血供,使瘤体缩小,降低后续RFA治疗的难度,减少消融相关并发症。     

脊柱肿瘤术前选择性动脉栓塞术的临床价值

目的探讨脊柱肿瘤术前选择性动脉栓塞术的临床应用价值。方法回顾性分析2017年1月至2018年12月于中国医科大学附属盛京医院骨科行脊柱肿瘤切除手术的42例患者的临床资料,依据肿瘤切除术前是否行动脉栓塞治疗,将患者分为栓塞组(20例)和未栓塞组(22例),再根据手术方式分为椎体切除亚组和椎板切除亚组。栓塞组椎体切除12例、椎板切除8例;未栓塞组椎体切除13例、椎板切除9例。采用独立样本t检验比较各组间术中失血量、红细胞输入量、校准失血量、手术时间和住院时间的差异。结果栓塞组20例患者均成功实施了脊柱肿瘤动脉栓塞术,无严重并发症发生。栓塞组与未栓塞组患者术中失血量、红细胞输入量、校准失血量、手术时间和住院时间,差异均无统计学意义(P>0.05)。栓塞组椎体切除患者,术中失血量、红细胞输入量和校准失血量分别为(1966.7±898.8)ml、(7.42±3.27)U和(91.3±39.2)g/L,未栓塞组椎体切除患者分别为(2838.5±1143.5)ml、(11.04±4.08)U和(133.0±46.4)g/L,差异均有统计学意义(t值分别为-2.107、-2.436、-2.419,P<0.05);而2组手术时间和住院时间差异均无统计学意义(t值分别为-0.780、-0.549,P>0.05)。栓塞组与未栓塞组椎板切除患者的上述各指标差异均无统计学意义(P>0.05)。结论脊柱肿瘤术前选择性动脉栓塞术相对安全。脊柱肿瘤术前动脉栓塞不能减少外科切除手术的失血量,但对外科术式加以区分后,术前栓塞可显著减少接受椎体切除手术患者的失血量,而椎板切除手术的患者无明显受益。     

原发性肝癌合并下腔静脉-右心房癌栓17例介入治疗体会

目的 评价TACE治疗原发性肝癌合并下腔静脉(IVC)-右心房(RA)癌栓的安全性和临床疗效.方法 17例原发性肝癌合并IVC-RA癌栓患者,行选择性动脉造影确认肿瘤供血动脉,之后行TACE.栓塞材料包括化疗药物-碘化油混合乳剂及颗粒型栓塞材料,栓塞的靶血管包括肝动脉分支、右侧膈下动脉、胃左动脉分支等.术后定期随访,酌情行进一步治疗.结果 17例患者共行TACE治疗45次,所有治疗均成功,无明显并发症.17例患者IVC-RA癌栓均可见明确供血动脉,肝动脉分支供血12例,肝外动脉供血9例,其中胃左动脉1例,右侧膈下动脉8例.复查CT,15例患者可见IVC-RA癌栓内碘油沉积.17例患者的中位生存期为12个月,1、2年生存率分别为52.9％、29.4％.结论 原发性肝癌IVC-RA癌栓血供丰富,主要供血动脉包括肝动脉、右侧膈下动脉,TACE是治疗原发性肝癌合并IVC-RA癌栓的安全有效方法.     

Preoperative arterial embolization of large liver hemangiomas

PURPOSE

We aimed to investigate the efficacy and safety of preoperative selective intra-arterial embolization (PSIAE) in the surgical treatment of large liver hemangiomas.

METHODS

Data of 22 patients who underwent resection of large liver hemangiomas were retrospectively analyzed. PSIAE was performed in cases having a high risk of severe blood loss during surgery (n=11), while it was not applied in cases with a low risk of blood loss (n=11).

RESULTS

A total of 19 enucleations and six anatomic resections were performed. Operative time, intraoperative bleeding amount, Pringle period, and blood transfusion were comparable between the two groups (P > 0.05, for all). The perioperative serum aspartate transaminase level was not different between groups (P = 1.000). Perioperative total bilirubin levels were significantly increased in the PSIAE group (P = 0.041). Postoperative hospital stay was longer in the PSIAE group. Surgical complications were comparable between groups (P = 0.476).

CONCLUSION

Patients who underwent PSIAE due to a high risk of severe blood loss during resection of large liver hemangiomas had comparable operative success as patients with a low risk of blood loss who were operated without PSIAE. Hence, PSIAE can be used for the control of intraoperative blood loss, especially in surgically difficult cases.Hepatic hemangiomas are the most common benign tumors of the liver. The incidence in autopsy series ranges from 0.4% to 7.3% (1). According to epidemiologic studies, estimated prevalence is 5% to 20% in the general population (2, 3). Most hepatic hemangiomas are less than 1 cm in diameter, and are usually followed without treatment in the absence of symptoms or complications. However, when they are large (>4 cm), patients may suffer from abdominal discomfort or pain caused by capsular stretch and experience early satiety from gastric compression. Additionally, spontaneous or traumatic rupture of a hemangioma is a mortal complication. In patients with large hemangiomas, consumptive coagulopathy with low platelet count and hypofibrinogenemia (Kasabach-Merritt syndrome) is also an important clinical problem.Management of patients with large hemangiomas of the liver has been controversial. Operative bleeding during enucleation or resection of a large liver hemangioma is an important cause of morbidity and mortality (4). However, preoperative embolization of large hemangiomas can reduce operative bleeding related with the hepatic arterial supply. Selective embolization through the left or right hepatic arteries is thought to reduce morbidity compared with nonselective embolization of the proper hepatic artery or ligation of the common hepatic artery (5).In the present study, the effect of preoperative selective intra-arterial embolization (PSIAE) of large hemangiomas on operative bleeding was evaluated retrospectively. Preoperative variables, complications, and the hospital course of patients were compared with the control group.     

Is a large fibroid a high-risk factor for uterine artery embolization?

OBJECTIVE: The objective of our study was to determine whether tumor size, specifically uterine fibroids of 10 cm or larger, predisposes a patient to an unacceptably high risk at uterine artery embolization. MATERIALS AND METHODS: One hundred fifty-two consecutive women underwent embolization for uterine fibroids. Complications and outcomes were analyzed using questionnaires and serial MRI between women with one or more uterine fibroids of 10 cm or larger diameter (mean, 12.4 cm; range, 10-19 cm) (n = 47, group 1) and women with each uterine fibroid of less than 10 cm diameter (mean, 6.8 cm; range, 2-9.5 cm) (n = 105, group 2). RESULTS: Thirty complications (19.7%, 30/152), which occurred in 27 women (17.8%, 27/152), were noted. However, 25 of 30 complications were minor, requiring no or nominal therapy. They occurred in 19.1% (9/47) of group 1 and in 15.2% (16/105) of group 2 women (p = 0.637). Major complications requiring major therapy, unplanned increased level of care, or unanticipated prolonged hospitalization (> 48 hr) or including permanent adverse sequelae were noted in 6.4% (3/47) of group 1 and in 1.9% (2/105) of group 2 women (p = 0.172). Of these five women, four underwent surgery because of sloughing fibroids. Permanent adverse sequelae were observed in one woman of group 1, who has had sexual dysfunction after embolization. No deaths occurred in either group. There was no significant difference in most outcomes or in intervals until the complete disappearance of postprocedural pain and full recovery between the two groups. CONCLUSION: We found no increased risk to patients undergoing uterine artery embolization for fibroids on the basis of tumor size. Successful outcomes can be obtained for such lesions.     

子宫动脉栓塞术在剖宫产术后子宫瘢痕妊娠治疗中的应用

目的探讨子宫动脉栓塞术(UAE)在剖宫产术后子宫瘢痕妊娠(CSP)治疗中的应用价值。方法 2007年1月至2011年6月共收治CSP患者35例,根据是否行UAE分为栓塞组(21例)和非栓塞组(14例)。栓塞组中,16例在UAE后24～48 h行清宫术,5例在UAE后行开腹或阴式病灶切除术。非栓塞组中8例直接行清宫术,3例病灶局部注射甲氨蝶呤后行清宫术,3例直接开腹行病灶切除术。比较两组患者术中出血量、住院时间、β-人绒毛膜促性腺激素(β-HCG)值降至正常时间的差异。结果栓塞组21例患者UAE操作成功,全部患者保留子宫,平均住院时间为(11.5±3.6)d,β-HCG值降至正常的平均时间为(18.6±4.9)d,而非栓塞组则分别为(20.4±5.2)d和(28.7±5.6)d。非栓塞组中2例由于术中出血汹涌,被迫行子宫切除术。结论 UAE术是一种有效的治疗CSP的方法,创伤小、成功率高,保留了患者的生育功能,能起到明显的防止出血和止血的作用。     

Efficacy of embolization in traumatic uterine vascular malformations

PURPOSE: To evaluate the efficacy of embolotherapy in patients with bleeding traumatic uterine arteriovenous malformations (AVMs). MATERIALS AND METHODS: A retrospective review of all patients who underwent pelvic arterial embolization at our institution between July 1992 and September 2002 was performed. Fifteen patients were diagnosed with a uterine vascular malformation on duplex ultrasonography and correlative MR imaging. Serial beta-human chorionic gonadotropin levels were measured to exclude gestational trophoblastic neoplasia. All patients underwent transcatheter embolization of the uterine arteries. Embolizations were performed with use of standard 4-5-F catheters and microcatheters when necessary. Embolic agents in the 25 procedures included glue only (n = 13), polyvinyl alcohol (PVA) particles and glue (n = 4), PVA particles (n = 2), Gelfoam (n = 2), coils (n = 1), PVA particles and coils (n = 1), glue and Gelfoam (n = 1), and glue and coils (n = 1). PVA particle size ranged from 350 to 1,000 micro m. Outcomes assessed were cessation of bleeding, persistence or resolution of the AVM, complications, and pregnancy after embolization. These were assessed by chart, laboratory, and imaging reviews. RESULTS: A total of 25 embolization procedures were performed in 15 patients. Six patients required repeat embolization (one patient underwent embolization on six occasions; five patients had two embolization procedures each) for recurrence of bleeding. Sixteen procedures were performed on an elective basis and nine were performed on an emergent basis. The technical success rate of embolization was 100%. The clinical success rate was 93%: bleeding was controlled in 14 of 15 patients and one patient underwent a hysterectomy. Four of the 15 patients subsequently had a total of five uneventful intrauterine pregnancies carried to term. The 14 patients who underwent successful embolization had no recurrence of bleeding at a median follow-up of 53 months (range, 3-124 months) after treatment. Three patients were eventually lost to follow-up. One minor complication (0.4%) of non-flow-limiting dissection of the internal iliac artery occurred. CONCLUSION: Percutaneous embolotherapy is a safe and effective treatment for traumatic AVMs. This procedure allows for preservation of uterine function with the possibility of future pregnancy and should be considered as a primary treatment option.