子宫动脉栓塞治疗子宫肌瘤伴月经过多的临床研究

目的:回顾分析24例子宫肌瘤伴月经过多患者入介治疗疗效和子宫动脉栓塞安全性.方法:选择24例子宫肌瘤伴月经过多患者进行子宫肌瘤供血动脉的栓塞.结果:插管栓塞动脉率100%,随访2年.治疗后1月,24例患者月经均明显减少,B超随访,3个月子宫肌瘤体积平均缩小30%.随访2年,其中2例行腹腔镜下子宫肌瘤经阴道摘除术,6例子宫肌瘤消失,16例子宫肌瘤体积平均缩小80%.结论:子宫肌瘤行介入治疗疗效肯定,对粘膜下子宫肌瘤及子宫肌瘤伴月经过多患者尤为适宜.     

探讨子宫肌瘤行子宫动脉栓塞介入治疗临床疗效

目的研究栓塞术治疗子宫肌瘤的临床应用疗效。方法 38例症状性子宫肌瘤患者,年龄29～58岁,平均年龄39岁。选择性双侧子宫动脉插管造影明确子宫肌瘤血液供应后,分别行栓塞术。结果栓塞技术成功率100%,子宫动脉栓塞术后12个月,总有效率为89.5%。术后38例患者月经量较术前均有不同程度减少,贫血及压迫症状均得到改善。副反应有盆腔疼痛、发热、阴道排液,余无其他严重并发症。结论子宫动脉栓塞术治疗子宫肌瘤安全、有效。     

动脉栓塞子宫肌瘤探讨(附19例报告)

目的　开辟简便、安全、疗效可靠、无损伤、痛苦小的子宫肌瘤栓塞治疗方法。方法　采用PVA加明胶海绵经Cobra4F超滑导管行子宫动脉栓塞。结果　3个月复查肿瘤缩小16.78%,6个月缩小21.40%,一年内缩小25%～55%。结论　子宫动脉栓塞治疗子宫肌瘤有很好的临床应用价值。     

子宫肌瘤动脉介入治疗

目的评价子宫动脉栓塞治疗子宫肌瘤的疗效和并发症. 方法对27例子宫肌瘤患者进行子宫动脉栓塞治疗,随访复查子宫、瘤体大小变化和临床症状、并发症的情况. 结果子宫动脉栓塞后随访3～18个月,有效率为92.6%(25/27).月经过多的改善率89.5%(17/19),痛经改善率88.9%(8/9),子宫体积减少48.9±15.6% (t=13.3921,p<0.001),肌瘤体积减少56.8±17.9%(t=14.6403,p<0.001);并发症发生情况:轻中度发热20/27(74.1%)、中重度腹痛5/27(18.5%)、月经周期缩短10/27(37.0%)、短暂性停经4/27(14.8%)、闭经2/27(7.4%).结论子宫动脉栓塞术治疗子宫肌瘤安全、有效、损伤小.但栓塞前需行活检术排除恶性病变.     

子宫动脉栓塞术用于治疗子宫肌瘤的护理总结

子宫肌瘤是育龄妇女生殖系统最常见的子宫良性肿瘤,尤其是35岁以上育龄妇女带瘤者为20%～25%,但大部分病人没有或仅有轻微症状而未进行诊疗.经皮超选择性子宫动脉栓塞治疗症状性子宫肌瘤,是近年来国内外开展的介入治疗新技术,与传统手术治疗方法相比,操作简单、安全,具有可保留子宫、损伤小、不需开腹,疗效确切,不良作用小等优点,从而得到了患者的认可[1].我院自2003年8月至2008年8月通过超选择性子宫动脉插管灌注平阳霉素碘油乳剂栓塞治疗子宫肌瘤病人220例,取得了良好疗效,现将护理体会总结如下.     

剖宫产后子宫动静脉瘘行子宫动脉栓塞术治疗的近远期疗效观察

目的：对子宫动脉栓塞术治疗剖宫产后子宫动静脉瘘的疗效进行研究和观察。方法剖宫产后,12例患有子宫动静脉瘘者给予Seldinger技术,首先进行穿刺、然后进行导管超选择插管,同时对双侧子宫动脉进行造影及栓塞治疗,对患者术后效果及术后6个月月经是否恢复进行观察。结果术后所有患者均停止出血,对患者随访6个月以上,病情好转的患者未出现异常出血。结论对剖宫产后患有子宫动静脉瘘的患者运用子宫动脉栓塞术治疗,可得到较好的疗效且远期不会复发。     

子宫肌瘤动脉介入治疗

目的　评价子宫动脉栓塞治疗子宫肌瘤的疗效和并发症 .方法　对 2 7例子宫肌瘤患者进行子宫动脉栓塞治疗 ,随访复查子宫、瘤体大小变化和临床症状、并发症的情况 .结果　子宫动脉栓塞后随访 3～ 18个月 ,有效率为92 .6 % (2 5 / 2 7) .月经过多的改善率 89.5 % (17/ 19) ,痛经改善率 88.9% (8/ 9) ,子宫体积减少 4 8.9± 15 .6 % (t =13.392 1,p<0 .0 0 1) ,肌瘤体积减少 5 6 .8± 17.9% (t =14 .6 4 0 3,p <0 .0 0 1) ;并发症发生情况 :轻中度发热 2 0 / 2 7(74 1% )、中重度腹痛 5 / 2 7(18.5 % )、月经周期缩短 10 / 2 7(37 0 % )、短暂性停经 4 / 2 7(14 .8% )、闭经 2 / 2 7(7.4 % ) .结论子宫动脉栓塞术治疗子宫肌瘤安全、有效、损伤小 .但栓塞前需行活检术排除恶性病变 .     

探讨2种栓塞剂联合对34例子宫肌瘤介入治疗的疗效观察

目的 评价两种栓塞剂联合应用栓塞子宫动脉治疗子宫肌瘤的临床价值.方法 对34例有症状的子宫肌瘤患者进行选择性的子宫动脉造影及栓塞治疗,并进行术后临床观察.结果 症状改善率为92.7%(29/34),其中月经完全恢复正常者占88.7%(28/34),其他症状消失者占85.6%(27/34)栓塞后6个月全部得到随访,子宫肌瘤平均缩小53.4%.结论 两种栓塞联合剂联合应用栓塞子宫动脉治疗子宫肌瘤是一种安全有效的新技术,值得在临床推广.     

超选择肾动脉栓塞治疗外伤性肾出血的临床应用

目的:探讨DSA下超选择肾动脉插管栓塞治疗肾损伤出血的临床应用价值.方法:28例外伤性肾脏出血患者,采用Seldinger's技术,先行肾动脉DSA造影.明确肾动脉主干或/和其分支损伤的部位及程度,在超滑导丝引导下超选择插管至出血动脉部位应用金属弹簧圈或明胶海绵颗粒进行栓塞治疗.结果:28例患者经DSA肾动脉造影后均能明确肾动脉出血的部位,经超选择插管金属弹簧圈或明胶海绵颗粒栓塞后均能有效止血,栓塞后造影显示出血动脉闭塞,造影剂外溢征象消失,术后1～3 d肉眼血尿消失.结论:DSA下超选择肾动脉插管栓塞治疗肾出血创伤小、疗效好、并发症少,而且能最大限度的保护肾功能,是治疗外伤性肾出血的一种安全、快捷、有效的方法.     

子宫动脉栓塞术治疗子宫肌瘤的护理

目的探讨双侧子宫动脉栓塞治疗子宫肌瘤的护理方法。方法采用Seldinger技术作选择性子宫动脉栓塞治疗196例子宫肌瘤病人,经股动脉穿刺分别入双侧子宫动脉,经导管注入平阳霉素碘油乳剂和明胶海绵颗粒,阻断其血供,并加强临床护理。结果196例子宫肌瘤介入治疗均顺利完成。术后1~3月随防,188例月经量减少或恢复正常,B超显示肌瘤缩小并与术前对比,肌瘤体积平均缩小45%~62%;8例症状无明显改善,行妇科手术切除。10例未孕者有4例怀孕生子。结论子宫动脉栓塞术是治疗子宫肌瘤安全、可靠、有效的方法。选择性双侧子宫动脉栓塞治疗子宫肌瘤,疗效确切,创伤小,是治疗子宫肌瘤的新途径。充分的术前准备、密切的术中配合、及术后并发症的严密观察是护理的主要环节。心理护理贯穿整个护理过程。     

Treatment outcomes of uterine artery embolization and laparoscopic uterine artery ligation for uterine myoma

In treating women with leiomyoma and who wish to preserve their uterus, laparoscopic uterine artery ligation or uterine artery embolization should be considered as possible options. This study was performed to evaluate the efficacy of laparoscopic uterine artery ligation and uterine artery embolization in treating uterine myoma. The treatment outcomes of 23 patients who underwent uterine artery embolization and 17 laparoscopic uterine artery ligation were evaluated. The uterine volume reduced 3 months after uterine artery embolization, but thereafter no significant changes were observed. On the other hand, the uterine volumes were only slightly reduced 3 months after laparoscopic uterine artery ligation, and slightly more reduced 6 months later. The average reduction in the case of laparoscopic uterine artery ligation was about 58.5%. After laparoscopic uterine artery ligation, 20% of the patients complained of vaginal spotting. Furthermore, the mechanism of volume reduction was evaluated using specimens obtained from a biopsy taken after each procedure. The results suggested that laparoscopic uterine artery ligation results mainly in physiologic cell death, that is apoptosis, whereas, the corresponding result is cell necrosis for uterine artery embolization. Uterine artery embolization and laparoscopic uterine artery ligation are both effective in relieving the symptoms caused by uterine myoma, and therefore both procedures can be used in place of hysterectomy or myomectomy.     

腹腔镜下子宫动脉阻断后子宫肌瘤剔除术的临床应用价值

目的探讨腹腔镜下子宫动脉阻断后子宫肌瘤剔除术临床应用价值。方法选择2011年1月至2015年1月我院接诊的子宫肌瘤80例患者进行研究。随机分为对照组和观察组,对照组(40例)实施腹腔镜下子宫肌瘤剔除术,观察组(40例)实施腔镜下子宫动脉阻断后子宫肌瘤剔除术,记录分析2组患者手术时间、住院时间、术中出血量、病发率和复发情况。结果 2组患者平均手术时间比较,差异无统计学意义(P0.05);观察组在排气时间与住院时间上均明显短于对照组,差异具有统计学意义(P0.05),对照组的术中出血量(145.20±35.50)mL,明显高于观察组(50.80±21.60)mL,差异具有统计学意义(χ~2=14.367 5,P=0.000 0);观察组术后月经过多改善率达100%,对照组仅为25%,2组比较差异具有统计学意义(χ~2=4.599 6,P=0.032 0);观察组无术后病率(体温高于38℃)、复发的情况发生,对照组术后病率和复发分别为5例(12.50%)和11例(27.50%),2组患者比较差异具有统计学意义(P0.05)。结论腹腔镜下子宫动脉阻断后子宫肌瘤剔除可显著降低患者术中出血量,缩短患者住院时间,降低患者术后并发症发生率,对子宫肌瘤的复发起到很好的抑制作用。     

Macro-microscopic changes in the uterine tube in uterine myoma

Macro-microscopic investigation and morphometry of uterine tubes in normal conditions and in uterus myoma has been carried out n 100 uterine tubes of 50 women at reproductive age. The data were obtained on peculiarities of the structure of different parts, thickness of the layers, changes of the blood supply and microarchitecture of the uterine tube wall in various phases of menstrual cycle in uterus myoma.     

Pathologic basis for abnormal uterine bleeding with organic uterine pathologies

Research is ongoing into the mechanisms of abnormal uterine bleeding, including bleeding from organic etiologies, where there is an intrinsic uterine lesion. Most of the current studies are focused on abnormalities of angiogenesis. By elucidating these mechanisms, targeted therapies can be developed. This article reviews the literature on pathologic mechanisms involved in bleeding from organic etiologies.     

子宫动脉栓塞治疗子宫动静脉瘘的疗效评估

目的探讨子宫动静脉瘘的诊断和栓塞治疗的价值。方法回顾性分析笔者所在医院6例子宫动静脉瘘彩色多普勒超声、血管造影和栓塞治疗结果。结果6例患者经彩色多普勒超声和血管造影检查明确诊断,均接受了双侧子宫动脉介入栓塞治疗，效果满意。结论子宫动静脉瘘在彩色多普勒超声检查中有典型表现，血管造影更加直观、准确，栓塞治疗可取得良好疗效。     

超声技术鉴别子宫肌瘤和子宫腺肌病

子宫肌瘤和腺肌病的准确鉴别在妇科临床诊治中有十分重要的意义,各种鉴别诊断技术中,超声技术因其无损性、简便性而成为常规的一种方法.超声成像技术是其中较为成熟的方法.在综述B型成像、彩色血流成像结合脉冲多普勒、彩色血流功率成像和三维彩色功率成像等四种超声成像技术鉴别子宫肌瘤和子宫腺肌病情况的基础上,介绍了两种新的超声鉴别方法:超声弹性检测技术、基于其他声学特征参数检测的组织定征技术.     

Abnormal uterine bleeding: the importance of uterine cavity visualization

Abnormal uterine bleeding is a common gynaecological problem.It is usually due to local pathology such as uterine myoma,endometrial polyp, or to anovulatory bleeding. Occasionally,it is a manifestation of a systemic disease. In this issue ofHuman Reproduction Update, Livingstone and Fraser discuss themechanism of abnormal uterine bleeding. They correctly statethat there are many causes of abnormal uterine bleeding andthat its mechanism is complex. Abbott and Garry discuss the treatment of abnormal uterine bleeding.They imply that the success rate of medical treatment is inferiorto that of surgical treatment. One of the accepted surgicaltreatments is endometrial ablation. If the first generationendometrial ablation is done under hysteroscopic control, someof the second generation techniques including the balloon technique,microwave endometrial ablation and others are performed blindly.These are acceptable techniques, providing a hysteroscopic evaluationof the uterine cavity is incorporated. Anecdotally, myself andothers have encountered a suspicious lesion just prior to anendometrial ablation that turned out to be endometrial cancer.This underscores the importance of visualization of the endometrialcavity prior to endometrial ablation. Without hysteroscopy,it is also difficult to ascertain the completeness of the ablation.Hysteroscopy is a powerful and yet simple technique to perform.I recommend hysteroscopy examination before and after non-hysteroscopicendometrial ablation. Missed intact endometrium after ablationcan then be removed. This is in disagreement with some thatpromote ‘office endometrial ablation’ without anyvisualization of the uterine cavity. Performing the procedureblindly is equivalent to returning to the old era of missingendometrial lesions with blind curettage. Approximately 10–15% of women require another surgeryfollowing endometrial ablation. Women with uterine myoma oradenomyosis tend to be in the ablation-failure group. Here,either uterine artery embolization or hysterectomy can be offered.Because the underlying pathology is above the cervix, a laparoscopicsupracervical hysterectomy is a viable option. I hope that the papers contained in this issue will provokemore research on the subject and will assist readers in themanagement of women with abnormal uterine bleeding.     

Gynaecoradiological uterine resection

We assessed the feasibility of performing uterine surgery underfluoroscopic control in an ambulatory setting that does notrequire operating room time and general anaesthesia. Four uterineseptae were resected and two cases of Asherman's syndrome weretreated using fluoroscopically guided scissors. All six surgicalprocedures were successfully completed. Gynaecoradiologicaluterine resection (GUR) procedures, utilizing fluoroscopy guidedscissors, are promising new techniques, which may allow thesuccessful performance of uterine surgery in a cost effectiveambulatory setting with no requirement of general anaesthesia.