子宫动脉栓塞术后子宫肌瘤病理改变的研究

近年采用经导管子宫动脉栓塞术治疗症状性子宫平滑肌瘤，已取得了良好的近期效果。对采用聚乙烯醇颗粒作为栓塞剂的子宫动脉栓塞术术后的病理改变的研究现状作一综述，研究子宫动脉栓塞术术后的病理改变对提高疗效，减少复发及术后的影像诊断均有重要意义。     

子宫肌瘤栓塞术中子宫动脉卵巢支的显示及其意义

目的　研究子宫肌瘤动脉栓塞治疗时 ,卵巢支显示与卵巢功能改变的关系。资料与方法　对 2 5 3例行动脉栓塞治疗子宫肌瘤患者进行回顾性研究 ,统计子宫动脉卵巢支显示类型 ,比较不同显示类型与发生停经、闭经的关系。结果　子宫动脉造影时 ,196例未显示卵巢血管 ,其中有 4例治疗后发生停经或闭经 ,5 7例显示卵巢血管 ,其中 5例发生停经或闭经。两者比较有显著性差异 (χ2 =4 .0 4 ,P <0 .0 5 )。结论　子宫动脉造影卵巢支显示的患者 ,卵巢功能可能易受影响 ,表现为发生停经或闭经者较多     

栓塞子宫动脉及供应子宫肌瘤的卵巢动脉治疗子宫肌瘤前瞻性研究

目的 观察有卵巢动脉供血的子宫肌瘤采用栓塞子宫动脉及供应子宫肌瘤的卵巢动脉的疗效及其对卵巢功能的影响.方法 用前瞻性研究方法对26例MR检查确诊有卵巢动脉供血的子宫肌瘤采用栓塞子宫动脉及供应子宫肌瘤的卵巢动脉,观察栓塞前、后不同时间卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)水平及子宫体积及肌瘤体积的变化.结果 患者术后1周至3个月FSH、LH增高,E2降低,术后6个月左右卵巢功能恢复正常,其中8例有明确的卵巢功能减退症状,但均为可逆性,无严重后果,2例继发闭经,考虑术后卵巢功能衰竭的发生与年龄有关,栓塞后子宫体积及肌瘤体积明显缩小.结论 有卵巢动脉供血的子宫肌瘤采用栓塞子宫动脉及供应子宫肌瘤的卵巢动脉,是安全和有价值的.     

症状性子宫肌瘤子宫动脉栓塞治疗的并发症

经导管子宫动脉栓塞是一项有望成为替代外科手术治疗症状性子宫肌瘤的新技术。大量临床研究肯定了经导管子宫动脉栓塞治疗症状性子宫肌瘤的疗效，该技术具有微创、安全等特点。随着治疗病例数的增多，子宫动脉插管和子宫动脉栓塞并发症已越来越引起人们重视。就症状性子宫肌瘤的子宫动脉栓塞治疗常见并发症以及这些并发症的预防和处理方法进行综述。     

子宫动脉栓塞术中附加栓塞侧支动脉的意义

目的 探讨子宫动脉栓塞术（UAE）中附加栓塞侧支动脉的可行性、安全性和有效性。方法 选取2012年1月～2019年8月瘢痕妊娠患者369例接受子宫动脉栓塞术联合宫腔镜清宫术,其中47例患者在子宫动脉栓塞术中进行了侧支供血动脉的尝试性栓塞。根据侧支动脉栓塞的成功与否将患者分成UAE+侧支动脉栓塞成功组和UAE+侧支动脉栓塞失败组,对两组患者进行了基础资料和临床疗效的对照。结果 29例患者（61.7%）侧支动脉栓塞成功,其余18例（38.3%）侧支动脉栓塞失败。两组患者的年龄、孕龄、发病至上次剖宫产术的间隔时间、胎囊直径、基础血清人绒毛膜促性腺激素（β-hCG）水平、胎囊与膀胱间的肌层厚度、β-hCG恢复至正常的时间均无差异。UAE+侧支动脉栓塞成功组的清宫术中出血量明显少于UAE+侧支动脉栓塞失败组。结论 在子宫动脉栓塞术联合宫腔镜清宫术治疗瘢痕妊娠中,侧支供血动脉栓塞在技术上是可行的,安全的,有助于减少清宫术中的出血量。     

经导管子宫动脉栓塞治疗症状性子宫肌瘤的临床观察

目的:探讨经导管子宫动脉栓塞术(UAE)治疗症状性子宫肌瘤的临床疗效及副反应。方法:选择有明显临床症状的32例子宫肌瘤患者,运用Seldinger技术超选择性子宫动脉插管,以平阳霉素碘油乳剂进行栓塞,术后3个月、6个月、8个月1、2个月观察疗效。结果:32例患者在术后随访12个月,子宫体积平均缩小60.6%,肌瘤体积平均缩小76.3%。所有病例,月经恢复正常,贫血改善,压迫症状基本消失,未出现严重并发症。结论:UAE治疗症状性子宫肌瘤是一种疗效显著、安全性高的微创治疗方法。     

子宫动脉栓塞术治疗子宫肌瘤

子宫动脉栓塞术(uterine arterial embolization,UAE)的临床应用已有20余年的历史.早在70年代初,髂内动脉及子宫动脉的血管造影和栓塞术已应用于外伤性盆腔出血的治疗[1].随后逐渐用于产科和妇科疾病的诊断和治疗,如产后及剖宫产后出血、异位妊娠、滋养细胞疾病引起的出血、妇科良恶性肿瘤术中及术后出血,以及盆腔动静脉畸形等[2-6].1995年,Ravina等[7]报道了UAE用于治疗子宫肌瘤,获得了满意的疗效,遂成为近几年介入放射学的一个热点.     

子宫动脉栓塞治疗子宫肌瘤的临床应用研究

分析子宫动脉栓塞治疗子宫肌瘤的有效性和安全性。材料和方法：５１例子宫肌瘤行子宫通读动脉栓塞治疗,分别于栓塞后１、３、６、１２个月行Ｂ超随访肿瘤体积变化。结果：现例均无子宫坏死一严重并发症。栓塞后６个月,肿瘤体积缩小大于５０％、２０％￣５０％和小于２０％者分别为４１例（占８０．４％）、９例（１７．６％）和１例（占２％）,其中２例肿瘤全部消失。所有病例临床症状减轻或消失。４例自然受孕。结论：子宫动脉栓     

子宫动脉栓塞术治疗子宫肌瘤临床观察

目的：研究经导管子宫动脉栓塞术治疗子宫肌瘤的临床效果。方法：选择子宫肌瘤患者21例，采用Seldinger技术行以侧子宫动脉插管，造影确认后注入PVA栓塞颗粒，阻断肌瘤血液供应。分别于术后3个月、6个月观察疗效。结果：子宫动脉栓塞术治疗后，肌瘤体积缩小（P＜0．01），月经恢复正常，贫血、压迫症状改善。保留了子宫和卵巢完整的生理功能。结论：子宫动脉栓塞术治疗子宫肌瘤是一种疗效显著的微创治疗方法。     

经导管子宫动脉栓塞治疗症状性子宫平滑肌瘤的初步经验

目的 评价经导管子宫动脉栓塞（ＵＡＥ）对症状性子宫平滑肌瘤（ＵＦ）的疗效并探讨治疗技术。方法 １０例患者主要症状包括阴道出血（月经过多）,盆腔压迫症状（尿频）,盆区疼痛。ＵＦ的诊断经影像学检查和专科医师检查确定,并排除与症状有关的其它妇科疾病。１０例患者行１１例次子宫动脉栓塞,其中双侧者１０例次,单侧者１例次。栓塞剂为ＰＶＡ微球。结果 栓塞技术成功率为１００％,无严重并发症。随访９例,术后症状有明     

子宫动脉栓塞术:两种栓塞剂对卵巢功能影响的对比研究

目的:探讨超液化碘化油、平阳霉素混合液在子宫肌瘤栓塞术中对卵巢功能的影响.方法:将83例子宫肌瘤患者分成两组进行栓塞治疗,其中A组(42例)采用聚乙烯醇微粒(直径500～700μm)作为栓塞剂,另外B组(41例)采用超液化碘化油和平阳霉素混合液作为栓塞剂.观察栓塞前后血清FSH、LH、E2水平变化及并发症发生的情况.结果:两组栓塞前及栓塞后3个月、6个月血清性激素变化没有统计学差异(P>0.05),B组出现1例永久性闭经及1例膀胱损伤.结论:从近期追踪观察来看聚乙烯醇和碘油、平阳霉素混合液两种栓塞剂在子宫肌瘤栓塞中对卵巢功能的影响没有统计学差异,但因为碘油的液体特性,一旦发生误栓易出现严重并发症,因此应慎重选择.     

影响子宫肌瘤栓塞治疗的因素

目的观察子宫动脉栓塞术(UAE)对子宫肌瘤的治疗效果,并分析影响疗效的因素。方法46例症状性子宫肌瘤患者经超选择性插管双侧子宫动脉内注入PVA微粒栓塞治疗,术后6、9个月随访复查,观察临床症状改善,肌瘤体积变化情况,并对临床上治疗效果与多种不同的影响因素进行分析。结果UAE术后临床症状改善,尤其以子宫出血症状改善最为明显,栓塞后6个月肌瘤体积平均缩小45.6%,9个月肌瘤体积平均缩小58.4%。盆腔内血管解剖、内分泌、栓塞技术及肌瘤类型等因素影响子宫肌瘤栓塞后的疗效。结论双侧子宫动脉栓塞治疗子宫肌瘤是一种安全、有效的方法,其疗效与盆腔内血管解剖、内分泌、栓塞技术及肌瘤类型等多种因素有关。     

Comparison of clinical and MR imaging outcomes after uterine fibroid embolization with Bead Block and Embosphere

Purpose

To compare clinical and imaging outcomes after uterine fibroid embolization (UFE) with Embosphere versus Bead Block microspheres.

Materials and methods

Our institutional review board approved this HIPAA-compliant study. We conducted a retrospective review of all consecutive UFEs performed for symptomatic uterine fibroids at our academic institution from 2001 to 2008. UFE was performed using Embosphere (n = 70) or Bead Block (n = 55) microspheres. Patient symptoms and MR images were reviewed before and following UFE. The MR images were analyzed for changes in the size and contrast enhancement of the dominant fibroid and the uterus.

Results

125 patients underwent UFE. Pre-treatment characteristics (patient age, presenting symptoms, fibroid location, and volume of the largest fibroid) were similar across groups. Procedure endpoint (near-stasis, reached in 94% of cases), duration, and sedation medication doses were also similar. Clinical follow-up was available in 69 (55%) patients (mean duration: 13.6 months). Of these, 92% had clinical improvement of their main presenting symptom(s) and 3% developed early menopause. MRI follow-up was available in 105 (84%) patients (mean 7.8 months). Mean volume reduction of the largest fibroid was similar after Embosphere (48%) and Bead Block (53%, p = NS). Residual enhancement ≥5% in the dominant fibroid was similarly uncommon after Bead Block (19%) or Embosphere (16%, p = NS). Mean uterine volume reduction was similar across groups (38%); no myometrial infarction occurred.

Conclusion

This retrospective study showed no superiority of Embosphere over Bead Block microspheres in terms of clinical and imaging outcomes after UFE.     

子宫动脉造影解剖分析及对栓塞治疗子宫肌瘤的指导意义

目的研究子宫肌瘤血管造影表现特点及其临床价值。方法75例患者,经临床症状,彩超和(或)CT检查确诊子宫肌瘤,其中黏膜下肌瘤9例,肌壁间肌瘤50例,浆膜下肌瘤16例;单发肌瘤21例,多发肌瘤54例。经右侧股动脉穿刺插管,导管分别插入双侧子宫动脉造影,观察内容包括：子宫动脉的起源及其分支、不同类型子宫肌瘤的血管造影表现,然后进行栓塞治疗。结果①大多数患者子宫动脉大部分发自髂内动脉的臀下动脉阴部干,其次为髂内动脉主干和臀上动脉。②子宫肌瘤供血情况分为：a、一侧子宫动脉供血为主型。b、双侧子宫动脉均衡供血型。c、单纯一侧子宫动脉供血型。③卵巢支的栓塞几乎不可避免,其临床后果仍存在争议。结论子宫动脉栓塞是治疗子宫肌瘤的一种安全有效的方法,熟悉子宫肌瘤的血管解剖对提高技术成功率、合理选用栓塞方法有重要意义。     

Review of readmissions due to complications from uterine fibroid embolization

AIM: To determine the frequency, nature and outcome of complications resulting in readmission to hospital following uterine artery embolization (UAE). MATERIAL AND METHODS: A retrospective review of the medical notes and available imaging of 42 consecutive patients who had undergone elective uterine artery embolization for the treatment of fibroid disease was performed. RESULTS: The mean age of the patients was 42 years (range 31--54 years) and seven patients (17%) were readmitted to hospital. The median time to readmission was 3 weeks (range 1-29 weeks). All seven patients were admitted with signs and symptoms of infection. In four patients an organism was isolated from high vaginal swabs, and in one patient the midstream urine sample was confirmed as the source of infection. In the other two patients no definite source of infection was identified. All patients were treated with intravenous antibiotics. Six of the seven patients responded to treatment. The remaining patient required hysterectomy for uncontrolled uterine sepsis. CONCLUSION: Readmission following UAE is common and arises secondary to infection. Infection can occur several months after the procedure.     

Effectiveness of intra-arterial anesthesia for uterine fibroid embolization using dilute lidocaine

A modified protocol of uterine fibroid embolization (UFE) is proposed for alleviating the postinterventional pain. This randomized and double-blinded clinical trial is to evaluate the effectiveness of intra-arterial infusion of dilute lidocaine for postinterventional pain relief in UFE. Forty-six patients who underwent UFE were randomly grouped equally. In the test group, after the poly(vinyl alcohol) embolization was complete, a dilute lidocaine solution with 40 mg in 6.0 ml, 3.0 ml for each side or 4.0 and 2.0 ml for two sides, was given through the catheter. In the control group, the patients received 6.0 ml of saline solution as a placebo. A simple pain degree classification method for patient self-evaluation was developed. A questionnaire was completed by each patient to record the degree of pain during five periods; these were during the procedure, the first 12 h, the second 12 h, between 24 and 48 h, and between 48 and 72 h. The numbers of patients with the same degree of pain in the five time segments from the two groups were statistically compared. Compared with the control group, the patients in the test group experienced less pain within 48 h after the procedure (p<0.01). The results suggest that this improved UFE protocol is a simple approach to prevent the acute postinterventional pain of UFE.     

Uterine fibroid embolization

Uterine fibroid embolization (UFE) is a minimally invasive therapy for the treatment of symptomatic uterine fibroids and offers an alternative to conventional myomectomy and hysterectomy. This review focuses on recent publications evaluating UFE and concludes that it is a safe treatment option, providing substantial improvement in both health-related quality of life and symptom control for most patients, with a very low rate of major complications. The durability of these outcomes appears similar to those obtained with myomectomy; however, a direct comparative long-term study is needed. Recent comparative studies have begun to provide more insight in to UFE outcomes compared with outcomes achieved with myomectomy and hysterectomy. UFE should be considered a first line therapy for women with symptomatic uterine fibroids. Additional research will continue to provide us with information as to the ideal candidates for UFE and may provide us with better tools to predict patient outcomes.