子宫动脉栓塞术治疗症状性子宫肌瘤

目的　评价经皮穿刺经导管子宫动脉栓塞术 (UAE)治疗症状性子宫肌瘤 (UF)的临床疗效。方法　 2 6例患者临床症状包括月经不规则 (月经量增多、月经经期延长 ) ,盆腔区坠痛 ,盆腔区压迫症状 (尿频或便意感 )及贫血。均采用经皮股动脉穿刺双侧子宫动脉插管 ,超选至双侧子宫动脉远端 ,用PVA微粒 ( 3 5 5～ 5 0 0 μm) 2 0例 ,丝线微粒 6例。 结果　所有病例经 6～ 18个月的随访 ,2 4例临床症状明显改善 ,2例无效 ,均是丝线微粒作为栓塞剂 ,13例 2～ 6个月B超随访瘤体体积缩小 45 %～ 75 %。无严重并发症。结论　子宫动脉栓塞术是治疗子宫肌瘤近期疗效显著、较为安全的一种微创治疗方法 ,远期效果有待进一步观察     

子宫动脉栓塞治疗子宫平滑肌瘤

目的 :评价经导管子宫动脉栓塞 (UAE)对子宫平滑肌瘤 (UF)的疗效及影响疗效的有关因素。资料和方法 :5 1例患者年龄 2 0～ 5 1岁 (平均 39 9岁 ) ,主要症状包括阴道出血 (月经过多 ) ,盆腔压迫症状 ,盆区疼痛。子宫平滑肌瘤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。 5 1例患者行 5 2例次子宫动脉栓塞 ,其中双侧者 49例次 ,单侧者 3例次。栓塞剂为直径 5 0 0～ 710 μ的PVA微球。 结果 :栓塞技术成功率为 94 2 % ( 49 5 2 ) ,无严重并发症。随访 44例 ,时间 2～ 19个月 ,术后症状有明显改善者 43例 ,无改善者 1例 ,与仅行单侧栓塞有关。术后 4个月肿瘤体积平均缩小 47%。结论 :UAE是一治疗UF的安全方法 ,近期疗效优良 ,远期疗效尚有待观察。影响疗效的主要因素为是否双侧栓塞子宫动脉     

经导管动脉栓塞术在子宫肌瘤中的应用

目的　探讨经导管超选择性子宫动脉栓塞术治疗子宫肌瘤的临床应用价值。方法　 10 3例子宫肌瘤 ,采用双侧子宫动脉插管造影和栓塞治疗 ,栓塞剂为聚乙烯醇 (PVA)和明胶海绵。 67例栓塞后随访资料完整 ,并对造影所见、治疗后反应、症状变化和肌瘤大小改变进行总结和分析。结果　造影表现为子宫动脉增粗、扭曲及肿瘤染色。治疗后数月内月经增多症状均有不同程度改善 ,肌瘤均有缩小 ,肌瘤缩小程度随时间延长而显著。结论　经导管子宫动脉栓塞术对控制症状、缩小肌瘤体积有显著作用 ,是一种安全、有效的治疗子宫肌瘤的方法     

子宫肌瘤的介入治疗

目的　评价子宫动脉栓塞术治疗子宫肌瘤的疗效。方法　对 182例子宫肌瘤患者进行超选择性子宫动脉栓塞术。结果　栓塞双侧子宫动脉 173例 ,单侧 9例。 168例完整随访者术后 6个月子宫体积平均缩小 42 % ,16例肌瘤消失 ,15 2例肌瘤体积平均缩小 67%。临床症状明显改善。主要副作用为下腹部疼痛 ( 13 5 /182 )。结论　子宫动脉栓塞术是治疗子宫肌瘤的良好方法。     

子宫动脉栓塞术治疗子宫腺肌病62例临床分析

目的探讨子宫动脉栓塞术治疗子宫腺肌病的临床疗效。方法对62例根据临床症状及超声诊断为子宫腺肌病的患者,行子宫动脉栓塞术。应用Cordis 4F Cobra导管完成双侧子宫动脉插管。先将超液化碘油加平阳霉素HPYM)乳化后进行栓塞,再用明胶海绵栓塞子宫动脉主干。术后观察病人痛经程度,月经量及子宫体积变化。结果62例病人栓塞后56例(90.3%)术后2月痛经症状完全消失;4例治疗后症状明显缓解,术后第四月痛经消失。52例患者月经量较术前明显减少,全部病例子宫体积及病灶呈进行性缩小。结论介入法子宫动脉栓塞术治疗子宫腺肌病,创伤小,安全性好;临床疗效显著,能显著改善了病人生活质量。     

子宫动脉栓塞术治疗植入胎盘的临床分析

目的 探讨子宫动脉栓塞治疗植入胎盘的价值.方法 16例经超声或磁共振检查确诊为植入胎盘患者行双侧子宫动脉注药栓塞术,栓塞后5～7 d在超声监视下行清宫术.结果 16例子宫动脉注药栓塞及清宫术治疗均成功.5～12个月内恢复正常月经.结论 双侧子宫动脉注药栓塞术及在B超监视下清宫术是一种治疗植入胎盘安全可靠有效方法.     

Quality and Reliability of YouTube Videos on Uterine Fibroid Embolization

PurposeTo evaluate the quality of information available in YouTube videos on the treatment of uterine fibroids.Materials and methodsThe DISCERN Scale Criterion was used to quantify the quality of YouTube videos on uterine fibroid embolization. The Video Power Index was used to quantify the popularity of videos on uterine fibroid embolization.ResultsAmong the 31 videos identified in the study, the average total DISCERN score was 48.82 ± 14.48, indicative of average to poor quality. There was no correlation between a video’s popularity and its quality. Popularity, as measured by Video Power Index, was not significantly different between videos containing a board-certified physician and those that did not. Videos with a board-certified interventional radiologist had a significantly lower Video Power Index than those without a board-certified physician.ConclusionYouTube is not currently a high-quality source of information for uterine fibroid treatment options. Physicians should be aware of highly viewed material on YouTube to have informed discussions with patients about their treatment options and address misperceptions.     

Uterine Artery Embolization for Pedunculated Subserosal Leiomyomas: Evidence of Safety and Efficacy

Purpose

To evaluate safety and efficacy of uterine artery embolization (UAE) for pedunculated subserosal (PS) leiomyomas.

Effect of Direct Marketing for Uterine Artery Embolization on Rates of Leiomyomas,Incidental Findings,and Management After Pelvic MRI

PurposeThe aim of this study was to determine whether a self-referred population screened by an interventional radiology (IR) clinic and a non-IR, physician-referred population differed with regard to suitability for uterine artery embolization (UAE) for symptomatic leiomyomas on the basis of preprocedure MRI.MethodsThis was an institutional review board–approved, HIPAA-compliant retrospective study of 301 women evaluated in an IR clinic for possible UAE from January 2009 to September 2012. Subjects were retrospectively divided into two groups: self-referred via direct marketing (group A, n = 203; mean age, 41.8 years; range, 22-58 years) and physician referred (group B, n = 98; mean age, 42.9 years; range, 30-65 years).ResultsThere was no significant difference between groups in presenting symptoms (multiple symptoms, bleeding, bulk-related symptoms, pain). After initial screening, 73.4% of group A (149 of 203) and 79.6% of group B (78 of 98) underwent MRI (P = .242). On the basis of MRI findings, 91.3% of group A (136 of 149) and 94.9% of group B (74 of 78) had uterine leiomyomas (P = .328). Adenomyosis without leiomyoma was present in 4.0% of group A (6 of 149) and 3.8% of group B (3 of 78) (P = .947). Incidental findings requiring further clinical or imaging evaluation were found in 20.8% of group A (31 of 149) and 24.4% of group B (19 of 78) (P = .539). After MRI, 41.6% of group A (62 of 149) and 48.7% of group B (38 of 78) proceeded to UAE (P = .306).ConclusionsAfter initial screening, similar proportions of self-referred and physician-referred patients were candidates for UAE. The rates of confirmed leiomyomas and incidental findings on MRI were similar between groups.     

子宫切除和子宫动脉栓塞对卵巢内分泌功能的影响

目的了解子宫切除和子宫动脉栓塞对卵巢功能的影响。方法对18例子宫切除患者,15例子宫动脉栓塞患者与3例正常妇女作为对照组分别测定血雌二醇(E2)、孕激素(P)、卵泡刺激素(FSH)、黄体生成素(LH)、泌乳素(PRL)水平。将这5种激素的测定结果,每2组之间分别进行比较。结果子宫切除组患者E2,P水平显著低于正常对照组(P均<0.01),2组之间差异有显著性;(2)子宫动脉栓塞组患者E2、P水平与正常对照组比较,差异无显著性(P>0.05);(3)子宫切除组PRL水平明显低于子宫动脉栓塞组。结论子宫切除后对卵巢内分泌功能有影响,子宫动脉栓塞对卵巢内分泌功能无明显影响。     

子宫肌瘤动脉栓塞治疗:对卵巢功能的影响及血清性激素的变化

目的:探讨子宫动脉栓塞术(UAE)治疗子宫肌瘤对月经和卵巢功能的影响。方法:66例子宫肌瘤行UAE后随访3～33个月,观察月经变化,其中15例在preUAE和postUAE3个月,监测血清黄体生成素(LH)、卵泡刺激素(TSH)、泌乳素(PRL)、孕酮(Prog)、雌二醇(E2)等5种性激素变化。结果:47例(81%)UAE后恢复正常月经或明显改善,5例(8.6%)有一过性月经紊乱,3例(5.2%)出现闭经(年龄>45岁)。14例血清5种性激素在preUAE和postUAE变化差异无显著性意义(P>0.05),1例(年龄46岁)5种性激素preUAE处于卵泡期水平,postUAE3月处于绝经期。结论:UAE治疗子宫肌瘤后,大部分患者可恢复正常月经,对卵巢功能影响小,对血清性激素水平无明显影响,但极少数年龄大于45岁者postUAE可出现闭经。     

The Role of Non-Contrast Cone Beam CT in Identifying Incomplete Treatment during Uterine Artery Embolization

PurposeTo describe the utility of post-procedure noncontrast cone-beam computed tomography (CT) in identifying cases of incomplete treatment and the need to search for additional vascular supply during uterine artery embolization (UAE).Materials and MethodsFrom June 2013 to June 2018, 427 patients (age, 45 ± 5 years) underwent 430 consecutive UAEs with post-embolization noncontrast cone-beam CT. If noncontrast cone-beam CT showed an area of the uterus lacking contrast retention, aortography was performed to search for collateral supply. Procedures were characterized as suspected complete bilateral UAEs or suspected incomplete UAEs, such as in cases of a unilateral uterine artery or diminutive uterine arteries. Rates of inadequate contrast retention on noncontrast cone-beam CT and discovered collateral artery supply were calculated. In 10 consecutive cases in which both noncontrast cone-beam CT and aortography were performed, dose-area product radiation exposure from noncontrast cone-beam CT and aortography was compared using a 2-sided paired-sample t-test.ResultsOf the 411 suspected complete bilateral UAEs, noncontrast cone-beam CT showed an area of the uterus lacking contrast retention in 38 (9.2%) cases. Of the 19 suspected incomplete UAEs, noncontrast cone-beam CT demonstrated incomplete treatment in 6 (31.6%) patients. Aortography was performed in 40 of the 44 cases of incomplete treatment on noncontrast cone-beam CT, and collateral supply was found in 28 (70.0%) cases. In 22 of these cases (5.2% of the 427 patients studied), noncontrast cone-beam CT led to the discovery of significant collateral supply requiring further embolization. Dose-area product radiation exposure from noncontrast cone-beam CT was less than from aortography (P = .007).ConclusionsPost-UAE noncontrast cone-beam CT can be used to select a subset of patients with a higher likelihood of collateral supply who may benefit from post-embolization aortography.     

子宫动脉栓塞治疗子宫肌瘤的并发症及防治

目的　总结子宫动脉栓塞治疗子宫肌瘤的并发症及防治经验。方法　自 1996年以来 ,使用子宫动脉栓塞治疗子宫肌瘤10 3例 ,除栓塞后综合征外 ,有 16例 18例次出现术后并发症。结果　除栓塞后综合征外 ,其它并发症包括 :动脉破裂 6例 ,子宫动脉痉挛 6例 ,肌瘤脱落 3例 ,停经 1例 ,膀胱误栓 1例 ,宫腔感染 1例。栓塞后综合征以对症治疗为主。动脉破裂后使用栓塞治疗未出现严重并发症。动脉痉挛使用解痉治疗 4例有效 ,1例出现假性栓塞 ,1例使用明胶海绵栓塞子宫动脉主干。脱落的肌瘤取出后采用止血、抗炎治疗 ,恢复正常。膀胱误栓使用对症治疗后无后遗症。宫腔感染采用子宫全切术后恢复正常。结论　正确处理术后并发症有利于提高治疗效果     

双侧子宫动脉栓塞术对预防和治疗产后出血的临床应用价值

目的：探究双侧子宫动脉栓塞术对预防和治疗产后出血的临床应用价值。方法54例出现难治性产后出血患者（治疗组）及40例具有产后出血高危因素的患者（预防组）均进行双侧子宫动脉栓塞术,观察疗效及出现的不良反应等。结果治疗组产妇治疗前已出现产后出血,出血量1100～4300 mL,平均2100 mL,辅助性背带缝合3例,宫腔填纱13例;预防组产妇出血量为210～490 mL,平均370 mL,所有患者均未发生产后出血;栓塞术后52例患者均有效,有效率96.3％,患者术后均未出现不良反应。结论双侧子宫动脉栓塞术是一种安全有效且不良反应小的治疗手段,对产后大出血高危因素患者有预防作用,是治疗难治性产后出血的有效方法。     

子宫动脉栓塞术治疗子宫肌瘤22例体会

目的　对不同类型子宫肌瘤进行子宫动脉栓塞治疗的临床应用研究 ,了解此方法疗效、副反应及并发症 ,探索治疗子宫肌瘤的新方法。方法　对 2 2例以子宫出血、月经失常、贫血、下腹包块等为主要表现的子宫肌瘤患者进行双侧子宫动脉栓塞 (1次 ,碘化油用量以瘤染色消失为限 ) ,随访复查瘤体大小、出血多少、月经、贫血等方面的变化。结果　随访 12个月 ,瘤块均有不同程度的缩小。其中 ,粘膜下肌瘤由术前 (8.7± 1.2 )cm缩小至 (2 .0± 0 .9)cm ,Ρ <0 .0 1;肌壁间肌瘤由术前 (7.2± 0 .8)cm缩小至 (1.4±0 .4)cm ,Ρ <0 .0 1;浆膜下肌瘤由术前 (6.4± 0 .9)cm缩小至 (2 .0± 0 .7)cm ,Ρ <0 .0 1。所有子宫出血病例 ,月经恢复正常 ;贫血病例 ,血红蛋白升至正常范围。无严重并发症发生。结论　子宫动脉栓塞术是治疗各种类型子宫肌瘤的一种安全、有效的新方法 ,对于想保留子宫、不愿手术、有手术禁忌证等情况的子宫肌瘤患者 ,不失为良好的选择     

动脉栓塞治疗子宫肌瘤三种栓塞剂动物实验比较研究

目的　通过比较聚乙烯醇 (PVA)微粒 ,平阳霉素碘油乳剂和无水酒精三种子宫肌瘤动脉介入治疗栓塞剂治疗结果 ,为介入栓塞剂临床应用的选择提供实验基础。方法　对 3 6只成年狗的子宫分别应用聚乙烯醇 (PVA)微粒 ,平阳霉素碘油乳剂和无水酒精三种栓塞剂 ,进行双侧子宫动脉栓塞 ,观察子宫病理变化和萎缩的情况。结果　栓塞术后 7、14、2 8d ,发现无水酒精组子宫发生了坏死穿孔 ,PVA和平阳霉素碘油乳剂组子宫缩小 7.3 %～ 2 8.2 % ,无严重并发症发生。结论　PVA和平阳霉素碘油乳剂是一种良好的子宫动脉栓塞剂 ,无水酒精应慎用。     

Safety and Efficacy of Repeat Embolization for Recurrent Hemoptysis: A 16-Year Retrospective Study Including 223 Patients

Purpose

To assess safety, efficacy, and long-term outcome of repeat bronchial artery embolization (BAE) for recurrent hemoptysis.

Post-Operative Hemorrhage after Myomectomy: Safety and Efficacy of Transcatheter Uterine Artery Embolization

Objective

To evaluate the safety and clinical efficacy of transcatheter uterine artery embolization (UAE) for post-myomectomy hemorrhage.

Materials and Methods

We identified eight female patients (age ranged from 29 to 51 years and with a median age of 37) in two regional hospitals who suffered from post-myomectomy hemorrhage requiring UAE during the time period from 2004 to 2012. A retrospective review of the patients'' clinical data, uterine artery angiographic findings, embolization details, and clinical outcomes was conducted.

Results

The pelvic angiography findings were as follows: hypervascular staining without bleeding focus (n = 5); active contrast extravasation from the uterine artery (n = 2); and pseudoaneurysm in the uterus (n = 1). Gelatin sponge particle was used in bilateral uterine arteries of all eight patients, acting as an empirical or therapeutic embolization agent for the various angiographic findings. N-butyl-2-cyanoacrylate was administered to the target bleeding uterine arteries in the two patients with active contrast extravasation. Technical and clinical success were achieved in all patients (100%) with bleeding cessation and no further related surgical intervention or embolization procedure was required for hemorrhage control. Uterine artery dissection occurred in one patient as a minor complication. Normal menstrual cycles were restored in all patients.

Conclusion

Uterine artery embolization is a safe, minimally invasive, and effective management option for controlling post-myomectomy hemorrhage without the need for hysterectomy.     

介入性栓塞治疗甲状腺机能亢进症

目的 :探索甲状腺动脉栓塞治疗甲状腺机能亢进 (简称甲亢 )的临床效果。材料和方法 :对 19例甲亢患者经甲状腺动脉超选择性插管 ,采用PVA ,硬脑膜微粒及钢圈栓塞治疗。结果 :甲状腺动脉超选择性插管、全部栓塞成功 ,13例甲亢症状缓解及T3、T4降至正常 ,所有的病例甲状腺体积有不同程度缩小 ,无严重并发症发生。结论 :甲状腺动脉栓塞治疗甲亢是安全、有效的方法。     

部分性脾栓塞术不同栓塞方法的对比研究

目的探寻脾亢患者部分性脾栓塞(PSE)术较为合适的栓塞方法。方法78例脾亢患者中32例为脾动脉主干内PSE术(主干组),46例为脾动脉分干内PSE术(分干组)。所有患者术后观察并发症情况,第15d、30d、60d、90d分别复查白细胞和血小板计数,并与术前比较,以此评价PSE术的疗效。然后对主干组和分干组结果进行对比分析。结果78例患者术后均无严重并发症,脾外栓塞及呼吸系统并发症分干组较主干组轻而少。术后白细胞和血小板计数,第15天时主干组和分干组比较差异均无显著性意义(P>0.05);第30天时二者比较差异均有显著性意义(P<0.05);第60天、90天时二者比较差异则均有非常显著性意义(P<0.001)。结论对于脾亢患者,脾动脉分支若呈二干型或三干型,则应尽量行分干内PSE术;分支若呈无干型或主干明显扭曲而插管困难时,则宜行主干内PSE术。