子宫动脉栓塞治疗子宫肌瘤的初步研究

目的 评价经导管子宫动脉栓塞法对子宫肌瘤的治疗作用。方法 28例病人（年龄36－48岁，平均41岁），有子宫肌瘤，顽固性阴道出血和腹痛，用PVA微粒行子宫动脉栓塞。术后3－12个月（平均5月）通过调查评估临床症状的改善。术前和术后3个月CT测量子宫和主要肿块的大小。结果 所有28例病人在技术上均成功栓塞。28名患中18名完成了调查表，显示症状明显好转的15例，无症状改善的1例，CT检查证实子宫体积和主要瘤体均大幅度缩小（平均缩小40％－65％）。结论 子宫动脉栓塞是一种很有希望的治疗子宫肌瘤导致的经血过多和盆腔疼痛的有效方法之一。     

经导管子宫动脉栓塞治疗子宫肌瘤的疗效及安全性评价

目的 探讨经导管子宫动脉椎塞（TUAE）治疗子宫肌瘤的疗效及安全性。方法 38例子宫肌瘤患者行经导管子宫动脉注射碘油平阳霉素乳剂栓塞治疗,其中5例于栓塞后1－3周行全宫切除或肌瘤剔除术,标本送病栓。另33例随访3－6个月,主要观察症状改善及肌瘤大小与子宫体积变化。结果 总的症状改善率90.6%（39／32％）,其中月经完全恢复正常点90.3%（28／31）,下腹部、腰腿胀痛消失占83.3%（25／30）,尿频、尿急等压迫症状消失占45.57%（5／11）。肌瘤体积平均缩小61.3%,子宫体积平均缩小50.6%,手术标本病理观察,碘油仅分布于肌瘤组织,栓后2周肌瘤出现点状坏死,3周出现大量片状坏死,而正常子宫肌组织未见异常。TUAE后未见严重并发症发生。结论 TAUE治疗子宫肌瘤具有明显的近期疗效,而且是一项安全的治疗方法。     

子宫动脉分次栓塞治疗巨大子宫肌瘤临床分析

目的：探讨分次栓塞子宫动脉治疗巨大子宫肌瘤的方法和临床疗效。方法：对18例巨大子宫肌瘤患者进行选择性子宫动脉造影及栓塞治疗。治疗前观察其子宫肌瘤血供特点、瘤体大小;其中10例栓塞材料用自制真丝线段颗粒（7号手术缝线）,8例用聚乙烯醇微粒（PVA,300～500um）及明胶海绵颗粒栓塞子宫动脉,栓塞治疗后造影证实子宫动脉栓塞的变化情况并随访。结果：血管造影显示子宫肌瘤血液供应丰富,主要由子宫动脉供血,左侧为主的7例（约占39%）,右侧为主的10例（约占56%）,双侧接近相同供血的1例（约占5%）。随访18例患者,随诊5年超声检查结果,子宫及肌瘤体积均明显缩小,子宫体积缩小33.7%～51.6%,肌瘤体积缩小48.3%～75.8%（P〈0.01）,5年内未发现术后再发肌瘤。结论：采用两次子宫动脉栓塞,使用普通导管、真丝线段栓塞经济有效;使用微导管采用远端聚乙烯微球近端加明胶海绵颗粒确切安全,疼痛等症状明显较一次栓塞轻,疗效好。     

静脉自控镇痛泵在子宫肌瘤栓塞治疗中的应用

目的 总结在子宫动脉栓塞治疗子宫肌瘤时,使用静脉自控镇痛泵对预防术中及术后疼痛及介入相关指标临床疗效和经验.方法 109例子宫肌瘤行双侧子宫动脉栓塞的病例,采用碘油平阳霉素乳剂加明胶海绵颗粒为栓塞材料,其中80例使用静脉自控镇痛泵,另29例使用利多卡因100 mg（2 ml）加生理盐水4.0 ml稀释成6.0 ml,患者疼痛不适时由导管注入,必要时加肌肉注射度冷丁50 mg.记录栓塞治疗中及治疗后患者急性缺血反应和症状.结果 与未使用静脉自控镇痛泵的病例相比,使用静脉自控镇痛泵患者术中及术后疼痛症状明显减轻,镇痛效果达85 %（68/80例）,与常规镇痛存在显著差异性.结论 子宫动脉栓塞治疗子宫肌瘤时使用静脉自控镇痛泵可以显著减轻常规栓塞治疗时的疼痛症状,是一种操作简单,效果好的方法,可推进子宫肌瘤动脉栓塞术的广泛应用.     

栓塞子宫动脉治疗症状性子宫肌瘤的探讨

目的探讨运用无水酒精超液化碘化油乳剂栓塞子宫动脉治疗症状性子宫肌瘤的临床疗效。方法症状性子宫肌瘤患者均采用经皮股动脉穿刺,双侧子宫动脉插管,超选择至双侧子宫动脉远端,用无水酒精超液化碘化油乳剂栓塞。结果2例病人手术未成功,28例病人取得了手术成功。其中20例病人进行术后追综随访,18例取得了不同程度的显著的临床疗效,2例效不明显,8例失随访。一例病人单侧子宫动脉供血,栓塞后疗效较差。结论无水酒精超液态碘化油乳剂选择性子宫动脉栓塞为非手术治疗症状性子宫肌瘤的较好方法。     

Uterine artery embolization for fibroids

UAE is an alternative to surgery for treatment of uterine fibroids that uses injections of small plastic or gelatin beads to thrombose fibroid vessels arising from the uterine artery. Clinical studies have reported less menorrhagia and pelvic pain in patients who have undergone the procedure. After embolization, many patients experience pain requiring an overnight hospital stay and administration of parenteral opioids. UAE is generally not recommended for women who have not completed childbearing.     

平阳霉素乳剂栓塞治疗子宫肌瘤的远期效果分析

目的探讨碘油平阳霉素乳剂经导管子宫动脉栓塞（LPE—TUAE）治疗子宫肌瘤的远期疗效及安全性。方法243例子宫肌瘤患者行LPE—TUAE治疗,其中14例于栓塞后3d至6个月行妇科手术切除,标本送病检。另229例随访1-4年,观察症状改善、肌瘤大小与子宫体积变化、卵巢内分泌功能改变及术后并发症。结果月经恢复正常或经血显著减少占96．0％（193／201）：下腹部、腰腿胀痛消失或明显缓解占94．9％（94／99）,压迫症状消失或显著减轻占96．0％（48／50）。B超复查,栓塞后1年、2年、3年和4年肌瘤平均体积缩小率分别为60．7％、63．3％、65．6％和67．4％,子宫平均体积缩小率分别为49．6％、54．3％、55．2％和57．1％．栓后3-4年肌瘤复发率10．8％（12／111）。卵巢内分泌功能观察栓塞前后无显著变化。手术标本病理观察,碘油仅分布于肌瘤组织,栓后2周肌瘤出现点状坏死,3周出现大量片状坏死,而正常子宫肌组织未见坏死。未见严重并发症发生。结论LPE—TUAE治疗子宫肌瘤具有较好的远期疗效,对卵巢功能及正常子宫肌组织无明显损害,无严重并发症发生。     

子宫动脉栓塞术的围手术期观察及护理

目的:探讨子宫肌瘤患者行子宫动脉栓塞术的围手术期观察与护理.方法:对78例子宫肌瘤患者,采取积极、充分的术前准备,术中、术后严密细致观察和及时适当的护理.结果:78例子宫肌瘤患者住院期间未出现因护理不当所致的并发症.结论:加强术前心理干预和术后护理是提高子宫肌瘤栓塞术的重要措施之一.     

子宫肌瘤的动脉栓塞治疗

子宫肌瘤是女性生殖系统最常见的良性肿瘤,病因不明,一般认为与雌激素有关。肌瘤的大小与发病率随着年龄的增长而增长,在４０岁以上的白人妇女中发病率约２０％,在５０岁以上仍有月经的女性中发病率达４０％１;在未产妇中更常见;黑人女性发病率更高、发病时间更早;非洲－加勒比地区女性的发病率是白人的３～９倍。停经后肿瘤缩小。临床症状通常有月经不调、月经过多,而出血是粘膜下及肌壁间肌瘤的最常见症状,并常导致缺铁性贫血;肌瘤的肿瘤效应及增大的子宫可产生泌尿道及神经症状如腹胀及疼痛、下坠不适感。另外子宫肌瘤还可…     

子宫肌瘤栓塞术的临床观察

目的子宫动脉栓塞术(TUAE)对子宫肌瘤治疗后的临床及卵巢内分泌功能的观察.方法 65例病人采用Seldinger技术一侧经皮股动脉插管,超选择至双侧子宫动脉,用聚乙烯醇微粒(PVA)栓塞.每个病人随访3～12个月.结果 48例临床症状完全消失,17例明显好转,有效率100%,B超或MRI复查肌瘤缩小率为97%,无一例复发.无一例严重并发症,卵巢内分泌功能测试栓塞前后无明显差异(P>0.05).结论子宫肌瘤栓塞术治疗子宫肌瘤是一种疗效好,安全的治疗方法.     

经导管子宫动脉栓塞术治疗子宫腺肌症

子宫腺肌症是妇科常见病,以往该病的治疗方法是常规的药物治疗和手术切除。随着介入放射学的发展,国内外学者采用经子宫动脉栓塞术(TUAE)治疗子宫腺肌症1-2,取得了显著效果。我院应用介入治疗子宫腺肌症48例,均随访1年以上,疗效较好,现报道如下。1材料与方法1.1一般资料选择经药物保守治疗1～3年疗效不佳或无效的48例子宫腺肌症患者,行TUAE治疗。年龄28～47岁,平均40.2岁,临床表现均伴有继发性痛经1～5年,并呈进行性加剧,月经明显增多、经期延长,伴有不同程度的贫血。所有患者的诊断均由妇科检查和彩超表现(部分患者加行MRI检查)结合病…     

A systematic review and meta-analysis of the safety and efficacy of uterine artery embolization vs. surgery for symptomatic uterine fibroids

Purpose: The aim of this study was to systematically review the safety and efficacy of uterine artery embolization (UAE) versus surgery for symptomatic uterine fibroids.Materials and Methods: An electronic search of the Cochrane Library, PubMed, Embase and Web of Science databases was conducted from their inception to May 2017 for randomized controlled trials (RCTs) that assessed UAE versus surgery for the treatment of symptomatic uterine fibroids. The references of the included studies were also retrieved. Two reviewers independently screened the studies based on the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality. The meta-analysis was conducted using RevMan 5.3 software.Results: A total of seven RCTs involving 859 patients were included. The results of the meta-analysis showed a shorter hospital stay and recovery time for UAE as compared to surgery. Surgery was not reported to be better for improving health-related quality of life in any of the included studies. There were no significant differences in patient satisfaction (1-2 and 5 years), and intra-procedural complications or major complications (1 year). However, the rates of minor complications (1 year) and further interventions (2 and 5 years) were significantly higher in patients who underwent UAE rather than surgery. The rates of pregnancy and live births were significantly lower among patients who underwent UAE than surgery.Conclusion: UAE is safe and effective, and has the advantages of shorter hospital stay and recovery time as compared to surgery. However, UAE has the risk of re-intervention, and lower pregnancy and live birth rates.     

Contrast-enhanced sonography during uterine artery embolization for the treatment of leiomyomas.

Uterine artery embolization (UAE) is a successful and safe treatment for symptomatic leiomyomas. However, rare complications such as premature menopause and uterine necrosis can arise because of embolization of non-target tissues. We studied the feasibility of using contrast-enhanced sonography with intravenous SonoVue just before, during and after complete occlusion of both uterine arteries. In a patient with multiple, large, symptomatic leiomyomas, contrast-enhanced imaging established that the UAE was technically successful and that myometrial vascularity was not reduced. Our case suggests that ultrasound contrast agents may have a role in monitoring UAE and thus may help prevent ischemic complications. Further studies are required to confirm this.     

Uterine artery embolization as a treatment for symptomatic uterine fibroids: a review of literature and case report

PURPOSE: To provide a case presentation and review of the literature on uterine artery embolization (UAE) as a treatment alternative for symptomatic uterine fibroids and to guide the nurse practitioner (NP) in patient selection, education, and periprocedural management of patients undergoing this procedure. DATA SOURCES: Research articles, clinical articles, and case studies pertaining to UAE. CONCLUSIONS: UAE is a safe, well tolerated, and effective nonsurgical treatment option for symptomatic uterine fibroids. This uterus-sparing procedure has low complication rates with excellent clinical outcomes and high patient satisfaction rates. The majority of women who undergo UAE report marked reduction in the severity of fibroid specific symptoms and significant improvement in their quality of life. Uterine fibroids are common in women and often produce symptoms that have a negative impact on quality of life. IMPLICATIONS FOR PRACTICE: The NP is instrumental in identifying which patients may be appropriate candidates for UAE, educating them about the risks and benefits of the procedure, and managing these patients before and after the procedure.     

子宫动脉栓塞治疗子宫肌瘤的临床观察

目的探讨子宫动脉栓塞术(UAE)治疗子宫肌瘤的临床疗效。方法对105例根据临床症状、体征、彩色超声诊断的子宫肌瘤患者行UAE治疗,应用4.0~5.0 F Cobra导管或3.0 F微导管完成双侧子宫动脉插管,以混有抗生素的海藻酸钠微球(直径500~700μm)栓塞。术后观察月经量、子宫及肌瘤体积、卵巢功能等变化。结果治疗后平均观察(8.6±1.1)个月经周期,其中98例月经量明显减少(P<0.01),而月经周期、经期无明显变化;子宫与肌瘤体积平均缩小60.6%和83.1%(P<0.01);彩超检查显示子宫肌层及病灶内血流信号明显减少;卵巢内分泌功能无明显变化(P>0.05)。结论UAE治疗子宫肌瘤创伤小、近期疗效显著且安全。     

子宫肌瘤栓塞治疗超声复查疗效分析

目的:探讨子宫肌瘤栓塞后吸收、缩小的程度与时间的关系。材料与方法:42例子宫肌瘤超选双侧子宫动脉插管,用直径355～500μm的PVA100mg,栓塞不充分的加明胶海绵。结果:39例栓塞双侧子宫动脉,多以一侧为主,3例栓塞一侧子宫动脉,术后2,4,6,12个月复查超声,肌瘤平均缩小为:2月30%,4月45%,6月65%,12月80%。结论:子宫动脉栓塞治疗应用超声复查对比准确可信,肌瘤缩小与时间关系因肌瘤的大小、类型、栓塞程度的不同而异。     

Three-dimensional color Doppler sonography and uterine artery arteriography of fibroids: assessment of changes in vascularity before and after embolization.

OBJECTIVE: To assess the accuracy of three-dimensional color Doppler sonography and uterine artery arteriography in depicting changes in fibroid vascularity before and after embolization. METHODS: Preembolization and postembolization three-dimensional color Doppler sonography and selective uterine artery arteriography were retrospectively compared in 15 patients who underwent uterine artery embolization for treatment of symptomatic fibroids. Three-dimensional color Doppler sonography was performed by using a scanner with color power angiographic imaging capability. Vascularity was quantified by using an estimation of power-weighted pixel density as described by our group in previously published studies. Uterine artery arteriography was performed by using a standard selective microcatheter embolization technique. For purposes of comparison, fibroids were classified as either hypervascular or hypovascular relative to myometrial vascularity before and minutes to several hours after uterine artery embolization. Changes in fibroid vascularity (i.e., from hypervascular to hypovascular) as depicted by three-dimensional color Doppler sonography were compared with those shown on uterine artery arteriography and classified as being in agreement or disagreement. RESULTS: In 13 (87%) of 15 patients there was agreement; in 2 (13%) of 15 there was disagreement. In both cases of disagreement, three-dimensional color Doppler sonography showed collateral flow not depicted by uterine artery arteriography The mean reduction in quantitated vascularity after uterine artery embolization was 44% (range, 19%-78%). CONCLUSIONS: Three-dimensional color Doppler sonography accurately depicts fibroid vascularity and in some cases can reveal collateral flow not depicted by uterine artery arteriography.     

Uterine artery embolization: sonographic imaging findings.

OBJECTIVE: To examine the sonographic and angiographic imaging findings before and after uterine fibroid embolization for symptomatic leiomyoma. METHODS: This prospective study involved 14 premenopausal women who underwent uterine fibroid embolization for symptomatic leiomyoma. Preprocedure sonography with color Doppler imaging was performed. Bilateral uterine artery embolization was successfully performed with the use of polyvinyl alcohol. Follow-up sonographic examinations were performed between 1 and 3 months after the procedure. The correlation between the sonographic appearance before and after embolization and the degree of decrease in uterine size was evaluated by using the Jonckheere-Terpstra 2-sided P test. RESULTS: Preprocedure sonographic imaging showed a varied appearance to the fibroids. Color Doppler imaging primarily showed the fibroids to be vascular with marked peripheral blood flow. Postprocedure sonographic imaging showed decreased uterine size and echogenicity. Color Doppler imaging showed a marked decrease in the blood flow to the leiomyoma. There was no statistical significance in the relationship between echogenicity and vascularity shown before the procedure and the percent decrease in the size of the uterus. CONCLUSIONS: Although sonography is an efficient method for identifying leiomyomata and determining the reduction in size after uterine artery embolization, we were unable to identify any predictive characteristics of success for aiding the preprocedural assessment.