经导管子宫动脉栓塞治疗子宫肌瘤

目的：研究经导管子宫动脉栓塞（TUAE）治疗子宫肌瘤的临床疗效。方法：对35例有症状的子宫肌瘤患者先行子宫动脉造影后,以碘油平阳霉素乳剂（LPE）及明胶海绵为栓塞剂,作选择性子宫动脉栓塞治疗。结果：血管造影发现,子宫肌瘤血供丰富,均由双侧子宫动脉供血,栓塞双侧子宫动脉后,子宫肌瘤血供可完全阻断,随访1－6个月时总的症状改善率90．9％（30／33）,其中月经完全恢复正常占90％（27／30）,下腹部、腰腿胀痛消失占83．3（20／24）,尿频、尿急等压迫症状消失占71．4％（5／7）,盆血症状改善100％（5／5）,栓塞后6个月肌瘤体积平均缩小59．2％,子宫体积平均缩小48．8％。结论：TUAE是一项治疗子宫肌瘤创伤小,临床效果好的新方法。     

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。     

子宫动脉栓塞治疗子宫肌瘤的观察与护理

目的观察子宫动脉栓塞治疗子宫肌瘤的疗效。方法对36例行子宫动脉栓塞的患者进行临床观察和护理。结果36例行子宫动脉栓塞术治疗患者，临床症状明显缓解．术后1～6个月子宫大小及肌瘤均有不同程度的缩小。结论子宫动脉栓塞可有效地缩小子宫肌瘤．并明显改善子宫肌瘤患者的临床症状。     

子宫动脉栓塞治疗子宫肌瘤32例分析

目的：研究子宫动脉栓塞对子宫肌瘤治疗的临床效果。方法：采用Seldinger技术行一侧或双侧股动脉穿刺，选择性双侧子宫动脉造影，了解子宫肌瘤供血情况，用PVA颗粒和明胶海绵栓塞子宫动脉，至主干栓塞。结果：子宫肌瘤供血丰富，双侧供血者29例，其中一侧优势型20例（64．7％），左右供血均衡型9例（25．9％），单侧供血者3例占9．4％。治疗后随访1－12个月，结果肌瘤均比治疗前缩小，月经量减少至原来的1／3－2／3，贫血及下腹坠胀症状明显改善，月经周期恢复正常，临床有效率约96．8％。结论：选择性子宫动脉栓塞是一种创伤小、临床效果好的新方法。     

子宫动脉栓塞治疗子宫肌瘤72例分析

目的：总结子宫动脉栓塞治疗子宫肌瘤的操作和临床经验。方法：72例子宫肌瘤患者,采用超选择性双侧子宫动脉插管的方法,进行造影和栓塞治疗,栓塞剂采用聚乙烯醇（PVA）和明胶海绵,栓塞治疗后观察术后反应和症状变化。结果：栓塞治疗成功率98．61％,造影显示子宫动脉增粗改变及肿瘤染色。肌瘤均有缩小（100％）,直径缩小1／3或以上者达72％。结论：子宫动脉栓塞治疗子宫肌瘤是一种成熟的和安全的治疗手段,创伤小,痛苦小,恢复快,对于不宜或不愿手术切除者尤为适用。     

介入治疗子宫肌瘤47例远期疗效分析

目的：评价子宫动脉栓塞术（TUAE）治疗子宫平滑肌瘤的远期疗效及安全性。方法：对47例子宫平滑肌瘤患者进行超选择性双侧子宫动脉栓塞术，观察其中长期临床疗效、并发症和肌瘤的再发情况。结果：随访12～60个月，月经量过多症状改善占97．4％（38／39），下腹压迫症状改善100％（23／23），B超复查TUAE后1a、3a、5a肌瘤平均体积缩小率为59．8％、63．2％、64．6％，子宫平均体积缩小率分别为51．3％、52．4％、55．6％（P〈O．001）。肌瘤栓塞后3a再发率4．25％（2／47），2例患者2次怀孕分娩。结论：TUAE治疗子宫动脉栓塞肌瘤远期疗效肯定、安全。子宫肌瘤栓塞后有一定的再发率。     

子宫动脉栓塞术在子宫肌瘤治疗中的价值

目的探讨经导管子宫动脉栓塞术（UAE）治疗子宫肌瘤的临床价值。方法选取症状性子宫肌瘤患者20例,行双侧子宫动脉插管,经导管注入聚乙烯醇颗粒行子宫动脉栓塞。术后随访观察6～18个月,了解症状改善及子宫和肌瘤大小变化。结果UAE术后2～6个月患者症状均有明显改善或消失,术后6～18个月B超显示肌瘤体积缩小30％～85％,平均缩小60％;子宫体积缩小25％～70％,平均缩小50％。没有严重并发症发生。结论UAE治疗子宫肌瘤是一项安全、有效的措施,值得在临床进一步推广。     

子宫动脉栓塞治疗子宫肌瘤初探

目的探讨子宫动脉栓塞治疗子宫肌瘤的临床疗效。方法采用Seldinger技术，行双侧髂内动脉-子宫动脉造影，了解子宫肌瘤的血供关系，再行相关选择性栓塞子宫肌瘤的供血动脉。结果24例患者中21例由双侧子宫动脉供血，占87．4％，3例由单侧子宫动脉供血，占12．6％。栓塞肌瘤供血动脉后患者原有症状消失。1、6、12个月后B超复查肌瘤，平均缩小41．57％、59．40％、70．04％，子宫体积缩小43．49％、63．08％、71．29％。总有效率为100％。结论子宫肌瘤供血动脉的栓塞是目前治疗子宫肌瘤的有效方法。     

经导管子宫动脉栓塞治疗子宫肌瘤

目的探讨经导管栓塞子宫动脉（TUAE）治疗子宫肌瘤的疗效。方法对38例子宫肌瘤患者分别经导管双侧子宫动脉注入平阳霉素超液化碘油乳剂栓塞，其中23例加用明胶海绵颗粒栓塞，术后3个月、6个月随访，对患者临床表现、肌瘤大小及雌激素水平变化观察对比。结果38例中有临床症状的35例术后3—6个月临床症状均有明显改善，术后3个月和6个月B超或CT复查肌瘤体积分别缩小39．7％、76．1％，FSH、LH、E2手术前后无明显变化。结论TUAE疗效可靠、操作简单、手术安全性高值得临床推广应用。     

超选择子宫动脉栓塞术对症状性子宫肌瘤患者生活质量的影响

目的：评价超选择子宫动脉栓塞术治疗症状性子宫肌瘤对患者生活质量的影响。方法：对22例症状性子宫肌瘤患者行超选择性子宫动脉平阳霉素碘油乳剂灌注。术后随访6个月，主要观察临床症状、肌瘤大小和子宫体积以及生活质量评分的变化。结果：患者术后6个月生活质量评分明显提高；术后2个月，14例患者月经量明显减少。术后6个月、22例患者月经周期均恢复正常，5例合并压迫症状者症状完全消失，合并严重痛经的9例患者症状明显改善，22例患者的血红蛋白含量均在100g／L以上；子宫体积平均缩小52．1％，肌瘤体积平均缩小了60．8％；无严重的并发症发生。结论：超选择子宫动脉栓塞术治疗症状性子宫肌瘤是一项安全、有效的新技术，可以提高患者的生活质量和生命活力。     

Prospective sonographic assessment of uterine artery embolization for the treatment of fibroids.

OBJECTIVES: To evaluate sonographic features following uterine artery embolization and to assess using ultrasound the efficacy of embolization as the primary treatment of fibroids. DESIGN: Fifty-eight women (mean age, 44.5 years; range, 33-65 years) suffering from symptoms due to fibroids (menometrorrhagia, bulk-related symptoms, pelvic pain) were followed-up after uterine artery embolization by ultrasound examination at 3 months, 6 months, 1 year and 2 years with assessment of volume and vascularization of fibroids as well as uterine vascularization. RESULTS: Fifty-eight patients were examined at 3 months, 46 at 6 months, 36 at 1 year and 19 at 2 years. Most patients were improved or free of symptoms at 3 months (90%), 6 months (92%) and 1 year (87%) and all monitored patients were free of symptoms at 2 years. Clinical failure of treatment occurred in only two cases (3%). Progressive significant reduction in fibroid size with reference to the baseline was demonstrated during follow-up from 3 months (-29%) to 24 months (-86%). Absence of intrafibroid vessels was observed in all except three cases as early as 3 months, whereas perifibroid vessels persisted in 21 cases. No changes in uterine vascularization or uterine artery resistance were noted. CONCLUSIONS: Uterine artery embolization is a valuable endovascular method for the treatment of fibroids, resulting in marked reduction in fibroid size and disappearance of intrafibroid vessels without reduction in uterine vascularization which is well depicted by sonography.     

选择性子宫动脉栓塞术治疗子宫肌瘤的探讨

目的评价选择性子宫动脉栓塞术治疗子宫肌瘤的临床疗效及应用价值。方法19例子宫肌瘤患者均采用经右侧股动脉穿刺双侧子宫动脉超选择性插管,使用聚乙醇＋明胶海绵颗粒栓塞双侧子宫动脉,阻塞肌瘤血供。结果全部病例随访3～24个月,8例肌瘤体积缩小大于50％,9例肌瘤体积缩小20％-50％,月经量和月经周期恢复正常,1例缩小〈20％,临床症状明显改善,1例无明显变化。治疗后3个月18例患者血红蛋白升至105g/L以上。无1例严重并发症发生。结论选择性子宫动脉栓塞术治疗子宫肌瘤是一种安全、简便、创伤小、疗效高的治疗方法,具有较高的临床应用价值。     

Role of uterine artery Doppler flow in fibroid embolization.

OBJECTIVE: To determine whether Doppler flow measurements are useful in predicting variables associated with uterine fibroid embolization, including shrinkage of the uterus and myomas, adenomyosis, and uterine fibroid embolization failure. METHODS: A group of 227 patients with menorrhagia or postmenopausal bleeding secondary to uterine myomas were evaluated with uterine artery Doppler flow sonography before uterine fibroid embolization. Doppler flow measurements were repeated 6 months after uterine fibroid embolization for 188 of the patients. Data were analyzed for correlations between peak systolic velocity and uterine fibroid embolization patient data, including size and shrinkage of the uterus and myomas, embolization particle size, adenomyosis, and uterine fibroid embolization failure. RESULTS: Initial peak systolic velocity was positively correlated with the size and shrinkage of myomas and uterine volume. Peak systolic velocity was positively correlated with the size and load of embolization particles and was significantly lower (mean, 33.2 cm/s) in patients with adenomyosis than those without adenomyosis (mean, 39.3 cm/s). High peak systolic velocity (>64 cm/s) was a significant predictor of failure. Postembolization peak systolic velocity (mean, 21.85 cm/s) was significantly lower than preembolization peak systolic velocity (mean, 40.33 cm/s) and was not correlated with uterine fibroid embolization variables. CONCLUSIONS: Doppler flow measurements can aid in predicting adenomyosis and uterine fibroid embolization failure. Postembolization peak systolic velocity did not show value.     

经皮肾镜取石术后大出血肾动脉数字减影血管造影表现及介入治疗

目的探讨经皮肾镜取石术(PCNL)后大出血肾动脉数字减影血管造影(DSA)表现及介入栓塞治疗的价值。方法收集2012年1月-2015年6月PCNL术后大出血患者34例,均经肾动脉DSA检查,并采取超选择性肾动脉栓塞(SRAE)治疗,栓塞材料为微弹簧毛圈、电解脱弹簧圈和/或生物胶(GLUBRAN2)。术后随访6个月~1年。结果 34例患者中DSA表现为肾动脉分支假性动脉瘤(RAP)22例(64.7%),肾动静脉瘘(RAVF)8例(23.5%),RAP伴RAVF 4例(11.8%)。所有患者均一次栓塞成功,技术成功率及止血率100.0%,最大程度保留病肾组织及功能,无严重并发症发生,术后随访6个月~1年,全部病例无血尿复发,肾功能正常。26例患者术后出现不同程度的栓塞综合征。结论 RAP、RAVF是PCNL术后肾动脉损伤导致大出血的主要类型;采用微弹簧毛圈、电解脱弹簧圈和/或GLUBRAN2胶行SRAE创伤小、止血迅速彻底,能最大限度保留肾组织及功能,是PCNL术后大出血的首选治疗方法。     

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.     

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。     

原发性肝癌破裂出血的介入治疗

目的：分析原发性肝癌破裂出血经皮肝动脉介入栓塞治疗的效果。方法对32例原发性肝癌破裂出血,行碘油与明胶海绵联合弹簧钢圈、平阳霉素肝动脉栓塞治疗,分析其疗效。结果32例患者止血成功率为100%。术前平均动脉压（60.5±16.2）mmHg,术后平均动脉压（85.3±17.8）mmHg,术后血压明显升高,术后平均心率小于（115.5±22.8）次/分,术后1～6 h之后,无输血者的血红蛋白与入院时（68.1±11.5）g/L无明显下降。术后1、3、6、12、24和48个月生存率分别为96.9%（31例）、87.5%（28例）、62.5%（20例）、46.9%（15例）、34.4%（11例）及12.5%（4例）。结论经皮肝动脉栓塞术对治疗原发性肝癌破裂出血效果显著,不仅能达到立即止血目的,而且能治疗肿瘤,并为后继治疗创造条件。     

子宫动脉栓塞治疗子宫肌瘤后临床受孕的观察

目的　探讨子宫动脉栓塞治疗子宫肌瘤后的临床受孕率。方法　 3 3例子宫壁间肌瘤患者需行生育要求 ,采用Seldinger技术 ,行双侧子宫动脉栓塞术 ,追踪 3～ 16个月的临床受孕率。 结果　栓塞术后月经恢复多在 1～ 2个月 ,治疗后临床受孕率 48.48%。结论　子宫动脉栓塞术治疗子宫壁间肌瘤对需行生育要求的患者 ,是一种简单、有效可行微创方法 ,值得进一步探讨研究。     

Three-dimensional color Doppler sonography before and after fibroid embolization.

Three-dimensional color Doppler sonography was performed within 1 hour, 1 day, 3 months, and 6 months of fibroid embolization in 20 patients who had a total of 31 fibroids greater than 2 cm in average dimension. The greatest decrease in vascularity occurred 1 day after the procedure, whereas the greatest volume change was found at the 3 month follow-up examination. In about one half of the patients scanned, depiction of fibroid vascularity by color Doppler sonography was found to improve the delineation of the size, location, and extent of myometrial involvement. Hypervascular fibroids (12 of 31) tended to decrease in size after treatment more than isovascular (10 of 31) or hypovascular ones (9 of 31). Additional investigations that are similar to this one will be needed to determine if three-dimensional color Doppler sonography can be used to predict those who will be responders, partial responders, or nonresponders to embolotherapy.