子宫肌瘤栓塞术的临床疗效观察

子宫肌瘤是女性生殖系统最常见的良性肿瘤[1],发病率在育龄妇女中高达20%～25%[2].临床以经量过多、经期延长造成贫血,瘤体较大造成压迫症状而就诊.以往的治疗方法为子宫肌瘤摘除术或子宫切除术和药物治疗,两者均可造成患者生理和心理影响.现对25例子宫肌瘤患者进行子宫动脉栓塞(UAE)治疗的临床疗效介绍如下.     

Long-term outcome of uterine artery embolization for symptomatic uterine leiomyomas

PURPOSE: To evaluate long-term outcomes and factors associated with treatment failure after uterine artery embolization (UAE) in women with symptomatic uterine leiomyomas. MATERIALS AND METHODS: One hundred consecutive women treated with UAE for symptomatic uterine leiomyomas participated. Clinical outcome data (ie, changes in symptoms, menstrual status, subsequent therapies) and satisfaction data were collected. Treatment failure was defined by subsequent major surgery (ie, hysterectomy or myomectomy), a second embolization, or a lack of symptom improvement at the patient's final follow-up interval. Possible predictors of failure were age, clinical baseline characteristics (ie, bleeding, pain, and bulk), and imaging results (eg, percent volume reduction of the dominant tumor). Cox proportional-hazards analysis was used to determine factors associated with failure. RESULTS: Follow-up was available in 93 women (median follow-up, 54 months; range, 45-87 y). Continued symptom relief was observed in 72% of patients (n = 67). Among the 26 women with treatment failure (28%), 11 (42%) underwent hysterectomy, four (15%) myomectomy, and eight (31%) repeat embolization. Three (12%) reported no improvement. In women without any additional surgery (n = 70), heavy menstrual bleeding, pain, and bulk-related symptoms improved in 97%, 93%, and 92%. Ninety percent of all women (n = 93) were satisfied or very satisfied at final follow-up. Predictors of failure were a lack of improvement in bleeding (hazard ratio [HR], 9.0; 95% CI, 3.1-26.3; P < .001) or pain (HR, 7.4; 95% CI, 2.2-24.4; P < .001) at 1 year after UAE and the percent reduction in dominant tumor volume (HR, 0.97; 95% CI, 0.95-0.99; P = .007). CONCLUSIONS: UAE in women with symptomatic leiomyomas leads to long-term symptom improvement. Predictors of failure were a lack of improvement in bleeding or pain at 1 year and the percent reduction in dominant tumor volume.     

Limited efficacy of uterine artery embolization for cervical leiomyomas

PurposeTo explore the effectiveness of uterine artery embolization (UAE) in treating symptomatic fibroids in the uterine cervix.Materials and MethodsAmong 537 patients who underwent UAE, 10 who had fibroids located in the cervix were retrospectively analyzed. The mean diameter of the fibroids was 6.0 cm. Seven of the 10 patients presented a total of 10 fibroids in the uterine body or fundus simultaneously. Fibroids of the cervix and fibroids in the body or fundus were compared in terms of the effects of UAE on the treatment thereof and vascularity on angiographic findings. Cervical leiomyomas were classified into three grades based on the vascularity seen on aortography, from grade I, indicating poor vascularity, to grade III, indicating hypervascularity. Necrosis of fibroids was assessed by magnetic resonance imaging 3 months after UAE.ResultsComplete necrosis of leiomyomas in the uterine cervix was seen in only two of the 10 patients (20%), whereas all fibroids in the uterine body or fundus were completely infarcted (P < .05). Partial necrosis (PN) of the fibroid with a thin viable rim was seen in two patients, whereas PN with a thick rim was seen in four and no necrosis was seen in two. Grade I (ie, poor) vascularity was noted in five of nine patients (55.6%) with cervical fibroids larger than 3 cm.ConclusionsPoor vascularity was a frequent finding among cervical leiomyomas, and the outcomes of UAE for cervical leiomyomas were disappointing, indicating a need for caution in selecting and counseling patients for this treatment.     

Outcomes after uterine artery embolization for pedunculated subserosal leiomyomas

PURPOSE: To assess the safety and efficacy of uterine artery embolization (UAE) treatment of pedunculated subserosal leiomyomas. MATERIALS AND METHODS: A review of patients undergoing UAE in a 30-month period (July 2004 to December 2006) was performed. Cases in which a pedunculated subserosal tumor (volume>or=4 cm3) was embolized were analyzed. The preprocedural volumes of the pedunculated tumor and uterus and the diameter and vascularity of the tumor and stalk were recorded. Posttreatment sizes of the pedunculated leiomyoma, stalk, and uterus were recorded, as was the presence or absence of complication(s). RESULTS: A total of 240 patients underwent embolization. Pedunculated subserosal leiomyomas were treated in 16 women, with a technical success rate of 100%. Preprocedural mean tumor and uterine volumes were 372 cm3 and 789 cm3, respectively. The mean stalk diameter was 2.7 cm (range, 0.8-7.8 cm). All pedunculated leiomyomas exhibited enhancement on contrast agent-enhanced magnetic resonance (MR) imaging (n=13) or vascularity on Doppler ultrasonography (US; n=3). Stalk vascularity was noted on MR imaging in 13 patients and was not assessed in the remaining three, who underwent US imaging. Imaging follow-up (mean, 5.9 months after UAE) demonstrated mean tumor volume reduction of 39.3% (95% confidence interval [CI], 28.2%-50.5%) and mean uterine volume reduction of 37.6% (95% CI, 26%-49.3%). There were no cases of continued tumor perfusion and no major complications. There was one minor complication of prolonged hospital stay (36 hours) for pain control. CONCLUSION: UAE was successfully and safely performed for pedunculated subserosal leiomyomas, with a tumor volume reduction of 39% and no unique complications related to these lesions.     

子宫动脉血管内介入操作的技术分析

近年来,国内外已熟练开展利用子宫动脉栓塞术(uterine artery embolization,UAE)治疗子宫肌瘤,且已取得良好的临床治疗效果.但是盆腔空间相对狭窄,血管分支多,各血管分支易前后重叠,子宫动脉开口起源复杂,走行迂曲,髂内动脉与髂总动脉之间的夹角变化大,因此,子宫动脉起源、开口的清晰显示,熟练的子宫动脉内插管操作及适度的栓塞是该项技术治疗成功的关键.     

Reversal of flow in the ovarian artery during uterine artery embolization

Uterine artery embolization (UAE) is gaining increasing recognition as an effective treatment alternative to hysterectomy in select patients. As interventional radiologists gain more experience in the treatment of fibroids, new interest is being directed toward arterial communications between the uterine arteries and ovarian arteries. This case report focuses on the potentially serious complication of flow reversal up the ovarian artery into the aorta during UAE.     

子宫动脉栓塞术治疗子宫肌瘤的中远期疗效

子宫动脉栓塞术治疗子宫肌瘤具有确切的中远期疗效,但其并非一种根治性治疗手段,存在复发和出现新生肌瘤的可能,术后有必要进行长期临床和影像学随访,仍需进行大规模临床研究,分析与其中远期疗效相关的因素,以便指导临床工作。     

选择性子宫动脉栓塞术在症状性子宫肌瘤中的应用

目的 探讨选择性子宫动脉栓塞术治疗症状性子宫肌瘤的疗效和安全性.方法 2005年1月至2009年6月在复旦大学附属妇产科医院就诊的85例症状性子宫肌瘤行子宫动脉栓塞术,症状包括月经量增多、经期延长和邻近器官压迫为主要症状的子宫肌瘤患者,通过超选择性双侧子宫动脉插管,以直径500～710μm的聚乙烯醇颗粒和明胶海绵栓塞子宫动脉.结果 栓塞成功率达100%,无严重并发症.随访6～36个月,所有病例月经恢复正常;贫血病例,血红蛋白升至正常范围.术后6个月肌瘤平均缩小57.5%.结论 子宫肌瘤栓塞治疗创伤小,保留子宫,并发症少,是临床效果确切的一种新治疗方法.     

Sonography of delayed effects of uterine artery embolization on ovarian arterial perfusion and function

OBJECTIVE: We aimed to assess the delayed effects of uterine artery embolization on ovarian arterial perfusion and function by performing ovarian sonography immediately before and after uterine artery embolization, as well as several months later. CONCLUSION: Although persistent loss of detectable arterial perfusion after uterine artery embolization occurs in some women, most patients reestablish arterial perfusion and do not develop symptoms of ovarian failure.     

子宫肌瘤栓塞治疗操作技术及相关因素分析

目的 :对子宫肌瘤动脉栓塞治疗的操作技术及相关因素进行分析 ,以提高技术成功率 ,减少并发症和X线辐射。方法 :对 10 6例行子宫肌瘤动脉栓塞治疗的患者进行回顾性分析 ,比较不同设备和技术条件下的技术成功率 ,并比较用不同投照角度造影对子宫动脉的显示情况。结果 :早期在旧设备下治疗的 2 1例患者 ,有 2支子宫动脉插管未成功。后在新设备下治疗 85例 ,全部子宫动脉插管成功。正位造影子宫动脉显示满意和比较满意的占 9.0 %和 2 4.0 %,右倾斜和左倾斜 3 0°～ 40°造影分别为 5 4.0 %和 2 9.9%,两者差异有显著性意义。结论 :要安全、快捷地进行子宫肌瘤动脉栓塞治疗 ,良好的操作技术和设备条件是基础。为清楚显示子宫动脉起始处以指导插管 ,取左和右倾斜造影 3 0°～ 40°较正位要好。     

Primary bilateral ovarian artery embolization for uterine leiomyomatosis in the setting of a rare anatomic variant - hypoplastic uterine arteries

We present the case of a 50-year-old female who underwent bilateral ovarian artery embolization for uterine fibroids in the setting of hypoplastic uterine arteries. Ovarian artery embolization is usually conducted during uterine artery embolization for fibroids to increase the procedure success when ovarian feeders are seen. The bilateral ovarian artery embolization is rarely performed due to fears of amenorrhea and early menopause from decreased blood supply to both ovaries. According to our knowledge, this the first case report describing primary bilateral ovarian artery embolization in the setting of a rare anatomic variant- hypoplastic uterine arteries. The patient had complete resolution of symptoms from her uterine fibroids after treatment with bilateral ovarian artery embolization with no ovarian failure findings on the follow-up.     

经子宫动脉灌注和栓塞治疗输卵管妊娠

目的探讨经子宫动脉插管灌注和栓塞治疗输卵管妊娠的可行性、安全性和疗效。方法采用改良Seldinger技术,对42例输卵管妊娠患者行超选择性子宫动脉插管造影,根据造影表现类型不同,灌注甲氨蝶呤(MTX)50～100mg,灌注后用明胶海绵颗粒栓塞子宫动脉。术前和术后观察临床症状、测血β-hCG值和测量妊娠囊大小的变化,分别于术后0.5、6、12、24、36和48h测外周血MTX浓度。结果42例中38例获得成功,4例失败改行手术或腹腔镜治疗。治愈率为90.5%(38/42)。术后血β-hCG水平下降至正常平均所需时间(8.3±2.0)d,MTX用量为50mg、75mg后36h测不出血药浓度,用量为100mg的48h后血药浓度均值为0.01μmol/L。无不良反应。结论经子宫动脉灌注和栓塞治疗输卵管妊娠方法简便、安全、有效,无明显并发症,有望为输卵管妊娠特别是合并少量出血或预防高危大出血的首选疗法。     

Recovery after uterine artery embolization for leiomyomas: a detailed analysis of its duration and severity

PURPOSE: To determine the duration and severity of recovery after uterine artery embolization (UAE) for leiomyomas. MATERIALS AND METHODS: As part of a study comparing different embolic materials used for UAE, detailed data on the severity of postprocedural recovery were gathered in 99 patients. These data included patient-controlled analgesia records, visual analogue scale (VAS) pain scores of daily peak pain levels for 7 days, medication use in the first week, and severity of constitutional symptoms experienced over the course of the first month after the procedure. The VAS scale assesses acute pain severity on a 10-cm linear scale and yields a continuous measure from 1 to 10. The constitutional symptoms were scored based on a questionnaire. The data were analyzed with use of summary statistics, and linear regression analysis was used to determine the impact of various baseline factors on the severity of recovery. RESULTS: The mean peak VAS score for the first 24 hours after UAE was 3.03 (SD, 0.26) and the mean maximum score in the first week was 4.89 (SD, 0.26). Only 11 patients had an in-hospital VAS score greater than 7, and 19 had a VAS score of greater than 7 on any of the first 7 days after discharge. The mean number of oral narcotic tablets used per patient was 10.8 in the first week. Although 33 patients had a temperature higher than normal sometime in the first postprocedural week, high temperature (>38.5 degrees C) occurred in only two patients. There were no differences detected in the measured parameters based on the type of embolic material used. CONCLUSION: Despite the reputation of UAE to the contrary, when current techniques are used, recovery after UAE for fibroids is relatively mild, with few instances of severe pain, high fever, or severe constitutional symptoms.     

子宫动脉灌注与栓塞治疗输卵管妊娠的临床应用

输卵管妊娠的传统治疗方法是剖腹切除患侧输卵管或保守治疗。近年来采用子宫动脉灌注与栓塞,一方面可以抑制或杀死绒毛滋养细胞使异位胚囊发育终止、坏死、消散;另一方面使用非永久性明胶海绵颗粒栓塞子宫动脉,可使异位着床胚胎发生急性缺血坏死,避免开腹手术,保留完整的生育器官。尤其对未育妇女及一侧输卵管被切除的妇女,更具有临床价值。     

超声检查在子宫动脉栓塞治疗子宫肌瘤中的应用

超声检查在子宫动脉栓塞术中具有重要作用,术前超声检查观察子宫肌瘤大小、内部回声、数量、部位、血供丰富程度等,为治疗达到良好效果、进行病例筛选提供丰富的信息。超声可以反映子宫肌瘤治疗前后血流、体积、回声等的变化,是评价子宫动脉栓塞治疗效果的有效工具,对疗效的长期观察等都有很高的价值。     

Diffusion-weighted imaging for prediction of volumetric response of leiomyomas following uterine artery embolization: a preliminary study

Purpose

To determine if pretreatment apparent diffusion coefficient (ADC) of leiomyomas could predict volumetric response (VR) following uterine artery embolization (UAE).

Materials and Methods

We retrospectively studied 11 women who underwent pelvic MRI before and >120 days following UAE. MRI included conventional and diffusion weighted imaging sequences. Percentage change in leiomyoma volume was determined by multiplanar T2‐weighted imaging. A Pearson correlation coefficient was calculated between leiomyoma VR following UAE and the following pre‐embolization parameters: initial volume, relative enhancement, relative T2 signal intensity (SI) and ADC. Receiver operating characteristic (ROC) curve analysis was used to determine the sensitivity and specificity of ADC for predicting volumetric response.

Results

Twenty‐eight leiomyomas were included with a mean interval from UAE to follow‐up MRI of 207 days. The preprocedural volume of the leiomyomas ranged from 18 to 182 cm³ (median 47 cm³). and ADC ranged from 0.37 to 1.71 mm²/s (mean 0.80 mm²/s). All leiomyomas were 100% necrotic following UAE. Leiomyoma VR following UAE was 48% ± 3.5%. with significant correlation between VR and ADC (r = 0.41; P = 0.017) but no correlation with initial leiomyoma volume, relative T2 SI, or relative enhancement. Using a threshold of 0.875 × 10^?3 mm²/s, ADC could predict > 50% VR with sensitivity and specificity of 70% and 83%, respectively.

Conclusion

Pre‐UAE ADC of leiomyomas correlated significantly with percent VR following UAE. In contrast, no correlation was seen between VR post‐UAE and conventional imaging findings. This suggests that VR following UAE depends on leiomyoma histology reflected in DWI rather than features revealed by conventional MRI. J. Magn. Reson. Imaging 2011;33:641–646. © 2011 Wiley‐Liss, Inc.