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。     

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。     

子宫动脉栓塞治疗子宫肌瘤45例分析

目的 :总结子宫动脉栓塞术(uterine artery embolization,UAE)治疗子宫肌瘤的方法、疗效、并发症及处理方法。方法 :45例子宫肌瘤患者,其中肌壁间肌瘤31例,黏膜下肌瘤11例,肌壁间肌瘤合并黏膜下肌瘤3例;单发肌瘤21例,2个肌瘤9例,3个及以上15例。肌瘤直径2.5~4.0 cm 14例、4.0~8.0 cm 23例、8.0~10.0 cm 7例、10.0 cm 1例。栓塞剂使用平阳霉素-碘油(LPE)加明胶海绵条39例,PVA微球加明胶海绵条6例。结果:单侧股动脉穿刺插管成功率98.8%。所有肌瘤均呈双侧供血,双侧均衡型21例,右侧优势型13例,左侧优势型11例;30例子宫动脉分出卵巢动脉支。UAE治疗后肌瘤及宫体平均缩小率分别为:术后1个月,43.4%、31.2%;3个月,51.6%、38.1%;6个月,57.6%、51.3%;12个月,72.1%、55.2%;15个月,74.1%、56.3%。结论:UAE治疗子宫肌瘤疗效确切,并发症较轻、发生率低,值得临床推广应用。     

子宫肌瘤子宫动脉栓塞术前后的MRI表现

目的　探讨子宫肌瘤子宫动脉栓塞术 (UAE)前后的MRI表现。方法　对 34例子宫肌瘤患者 (共 6 2个肌瘤 )在UAE前和术后 4个月行MR平扫和增强检查 ,肌瘤信号强弱与骨骼肌相比较 ,肌瘤体积测量按椭球计算公式。结果　 6 2个肌瘤术前平均体积为 85 6cm3 (范围 0 3～2 4 8 4cm3 ) ;UAE后 4个月肌瘤平均体积为 32 6cm3 (范围 0 3～ 6 5 4cm3 ) ,体积总缩小率为 5 8 32 % (t=3 18,P <0 0 1) ,术前体积大于 35cm3 的 4 0个肌瘤缩小率为 6 2 4 8% (t=4 4 5 ,P <0 0 1) ;而术前体积小于 35cm3 的 2 2个肌瘤体积缩小率为 38 6 9% (t=1 13,P >0 0 5 )。UAE后T1WI上肌瘤信号 38个为均匀等、低信号 ,2 0个呈等信号 ,4个为稍高信号 ;T2 WI上肌瘤信号 5 5个为极低信号 ,7个为稍低信号。UAE后 4 0个较大肌瘤中 38个无强化 ,而 2 2个术前体积小于 35cm3 的肌瘤仅 5个无强化 ,17个仍有不同程度强化 ,正常子宫肌层强化明显。结论　MRI有助于评价子宫肌瘤UAE前后的体积和血供改变。     

UAE治疗不同类型症状性子宫肌瘤中期疗效及安全性研究

目的 探讨子宫动脉栓塞术(UAE)治疗不同类型症状性子宫肌瘤中期临床疗效和安全性。方法 回顾性分析行UAE治疗的33例患者的临床资料,分析患者术后月经评分、临床有效率、不良反应及并发症,比较术前和术后6个月肌瘤体积缩小率、月经量减少率,比较术前和术后6个月不同类型症状性子宫肌瘤的疗效。结果 UAE治疗子宫肌瘤疗效确切,术前和术后6个月肌瘤体积缩小率、月经量减少率差异均有统计学意义(P<0.05)。对不同类型子宫肌瘤治疗效果无明显差异(P>0.05)。术后无严重不良反应及并发症发生。结论 UAE治疗症状性子宫肌瘤安全有效,对不同类型子宫肌瘤疗效无差异,在保留子宫的同时能显著缓解患者临床症状。     

高压明胶海绵微粒动脉内栓塞治疗子宫肌瘤的临床观察

目的:评价高压明胶海绵微粒作为栓塞剂动脉内栓塞治疗症状性子宫肌瘤的安全性和有效性。方法:用高压明胶海绵微粒动脉内栓塞治疗173例子宫肌瘤患者,随访3~36个月,平均15.7个月,观察临床疗效、肌瘤和子宫体积的变化。结果:术后4个月总的症状改善率98.84%(171/173),160例(92.49%)患者术后月经完全恢复正常;5例(2.89%)患者出现术后永久闭经;痛经与直肠和膀胱压迫等症状均完全消失。术后6个月子宫体积平均缩小49.35%,肌瘤平均缩小59.78%。结论:采用高压明胶海绵微粒作为栓塞剂栓塞子宫动脉治疗症状性子宫肌瘤是一种经济、安全、有效的新方法。     

子宫动脉栓塞治疗子宫肌瘤45例

目的评价经导管子宫动脉栓塞(UAE)对子宫肌瘤的疗效及影响疗效的有关因素。方法对45例子宫肌瘤患者进行超选择性子宫动脉栓塞,其中肌瘤多发36例,单发9例;肌瘤位于肌层41例(其中5例伴有子宫腺肌症,2例伴有黏膜下肌瘤);位于黏膜下4例。子宫肌瘤的诊断经影像学检查和妇科检查确定。术后超声、化验检查观察瘤体及激素水平和血红蛋白变化。结果45例患者91支子宫动脉(1例左侧为双子宫动脉)插管成功87支,成功率95.6%。45例均获随访,随访时间6～36个月。术后6个月肿瘤体积平均缩小69.3%,3例子宫肌瘤消失。贫血病例,血红蛋白升至正常。主要不良反应为下腹部疼痛和低热。结论子宫动脉栓塞是治疗子宫肌瘤的安全有效的方法。     

经导管子宫动脉栓塞术治疗子宫肌瘤的临床应用

目的 探讨经导管子宫动脉栓塞术(TUAE)治疗子宫肌瘤的方法、疗效及并发症.方法 本组82例,由临床、超声、CT检查确诊为子宫肌瘤,其中黏膜下肌瘤5例,肌壁间肌瘤72例,浆膜下肌瘤5例.单发肌瘤15例,多发肌瘤67例.采用Seldinger技术,经导管双侧子宫动脉注入超液化碘油-平阳霉素乳剂,然后以明胶海绵颗粒栓塞子宫动脉近端.栓塞后3个月、6个月回院复查.结果 插管成功率100%.随访3～6个月,所有病例在治疗后3个月B超示肌瘤体积平均缩小51%,瘤体内血流信号明显减少;6个月肌瘤体积平均缩小43%,其中19例肌瘤消失.所有病例月经恢复正常;贫血病例,血红蛋白升至正常范围.并发症发生率6%(5/82),经处理后均恢复正常.结论 TUAE治疗子宫肌瘤创伤小,疗效显著;TUAE并发症少,是可以防治的.     

子宫肌瘤栓塞中误栓卵巢支对卵巢功能的影响

目的评价子宫肌瘤栓塞中双侧卵巢支被误栓对卵巢功能的影响.方法将在子宫动脉造影中出现双侧卵巢支显影而被误栓的15例子宫肌瘤栓塞病人分成2组,1组是双侧卵巢区有碘油沉积(双侧卵巢碘油沉积组),另1组是双侧卵巢区无碘油沉积、或仅一侧卵巢区有碘油沉积(非双侧卵巢碘油沉积组),分别统计术后闭经的病例,并作Fisher检验.栓塞材料采用超液化碘油和平阳霉素混合液.栓塞前和栓塞6个月后检查促卵泡生成素(FSH)、黄体生成素(LH)和雌二醇(E2),并作t检验.结果 15例年龄26～46岁[(39.00±5.62)岁],追踪16～47个月[(30.5±6.4)个月].12/15的患者月经在栓塞后2～6周[(3.0±0.3)周]恢复,3/15的患者出现闭经,3例术后闭经的性激素呈绝经期改变.双侧卵巢碘油沉积组出现术后闭经(3/3),非双侧卵巢碘油沉积组未出现术后闭经(0/12),两组差异有统计学意义(P=0.002 19).≥45岁的患者有2例,均无术后闭经,<45岁的患者有13例,其中3例出现术后闭经.所有患者在栓塞前和栓塞6个月后的FSH、LH和E2差异无统计学意义(P>0.05).结论子宫肌瘤栓塞中双侧卵巢支被误栓后,若双侧卵巢区被碘油沉积,术后发生闭经的几率极高.若子宫动脉造影中出现双侧卵巢支显影的肌瘤患者,需要慎重选择栓塞剂,超液化碘油可能不是合适的栓塞材料.单纯的双侧子宫动脉卵巢支的误栓,即没有卵巢血管床的误栓情况下,对卵巢功能的影响可能较小.     

子宫动脉栓塞治疗子宫黏膜下肌瘤的疗效及安全性

目的 探讨子宫动脉栓塞术(uterine arterial embolization,UAE)治疗子宫黏膜下肌瘤的转归、疗效及安全性.方法 2008年1月至2011年10月收治 74例经超声及宫腔镜检查确诊的子宫黏膜下肌瘤患者,行UAE治疗,并观察术后疗效及安全性.结果 74例患者术后随访12 ～ 24个月,月经量均明显减少,贫血改善.70例患者肌瘤自阴道排出,2例回缩至肌层,2例肌瘤明显缩小.术中、术后不同程度疼痛71例,发热18例,分泌物增多50例,肌瘤排出过程中感染6例,经对症治疗后症状均逐渐消失.3例月经稀少,3例发生子宫性闭经,膀胱损伤1例,14 d治愈.术前、术后激素水平测定差异无统计学意义(P﹥0.05).结论 UAE治疗子宫黏膜下肌瘤疗效显著、微创、安全,但对于有强烈生育要求的患者应慎重选择.     

子宫动脉栓塞治疗子宫肌瘤的动态影像学监测及其机制研究

目的观察子宫动脉栓塞治疗子宫肌瘤术前、术后影像学动态变化,探讨其治疗机制。方法通过对45例子宫肌瘤患者行子宫动脉栓塞治疗,观察栓塞前后行盆腔彩色多普勒超声(彩超)、MR平扫加增强,以及栓塞后CT平扫检查,了解子宫及肌瘤影像学征象的动态变化。追踪时间3～16个月,平均(10.0±3.5)个月。结果术前41例彩超显示肌瘤血流丰富,术后第1天肌瘤和正常肌层血流消失,第7天肌瘤血流仍消失但正常子宫肌层血流开始出现;术后1、3、12个月正常子宫肌层血流恢复正常而肌瘤内仍无血流。4例术后第7天开始肌瘤内有血流信号,至术后12个月肌瘤内仍有血供。45例CT平扫发现术后当天肌瘤和正常肌层均有碘油沉积,以肌瘤明显,术后1、3、12个月正常子宫肌层碘油逐渐流失,而肌瘤内仍有碘油沉积。45例术前MRI肌瘤及子宫肌层均有明显强化,术后3个月MRI复查39例肌层有强化而肌瘤无强化改变;另6例术后肌瘤仍有不同程度强化。2例患者术后肌瘤脱落,病理证实为坏死组织。术前、术后肌瘤体积变化的监测,MRI与彩超测量结果的比较差异无统计学意义(P>0.05)。结论子宫肌瘤血管床出现选择性栓塞导致肌瘤坏死,是子宫动脉栓塞治疗子宫肌瘤的机制。其动态影像...     

子宫肌瘤动脉栓塞术后血流,女性激素变化及疗效的近、中期观察

目的　观察子宫肌瘤患者行动脉栓塞术后近、中期肌瘤体积 ,子宫及肌瘤血流的变化 ,临床症状的改善及女性激素水平变化的特点。方法　对 40例子宫肌瘤患者进行一次性双侧子宫动脉栓塞术术前及术后 3月、6月、9月、12月、2 4月、3 6月及 48月定期做超声测定肌瘤体积 ,子宫及肌瘤血流状态 ,定期测定血液中各类女性激素浓度 ,随访患者临床症状的变化。结果　所有患者术后各个时期随访 ,肌瘤内都未见血流信号。统计学数据表明 ,术后各期正常子宫血流与术前比较无显著差异。术后各期月经较术前明显改善 ,肌瘤显著缩小 ,与术前比较有显著差异。其中 ,术后 3～ 9月肌瘤持续缩小 ,且术后 3～ 9月之间各期肌瘤体积有显著差异 ,术后 9～48个月之间各期肌瘤大小测定无显著差异。术后各期HCG ,LH ,E2 ,FSH ,PRL ,P ,T激素水平与术前比较无差异。结论　子宫肌瘤栓塞术是一种有效的治疗手段     

Uterine artery embolization treatment of uterine fibroids: effect on ovarian function in younger women

PURPOSE: To evaluate how uterine artery embolization (UAE) treatment for uterine fibroids (UF) affects ovarian function in young Middle Eastern women. MATERIALS AND METHODS: In this prospective study, 32 patients (mean age, 34 y; range, 26-45 y) underwent UAE treatment of symptomatic fibroids. Serum follicle-stimulating hormone (FSH) levels were measured before and after the embolization treatment. Preprocedural levels were determined on the second day of the menstrual cycle. Postprocedural levels were measured 3 months and 6 months after embolization. A detailed history of menstrual cycles was obtained before and after UAE. RESULTS: Thirty premenopausal patients had normal menses before UAE. Mean FSH levels before and 3 months after UAE were 6.83 IU/L +/- 1.8 and 6.99 IU/L +/- 1.67, respectively (P =.66). Normal menstruation resumed 2-3 months after the procedure. In two perimenopausal women, who had irregular menses and decreased ovarian reserve, mean FSH levels increased transiently from 22 and 30 IU/L to 40 and 48 IU/L, respectively, 3 months after UAE; they developed transient amenorrhea. CONCLUSION: In this study, UAE had no clinically relevant adverse effects on normally functioning ovaries and could be used safely in the treatment of symptomatic fibroids in premenopausal women. Larger studies are required for further support of this observation.     

子宫动脉栓塞对子宫腺肌病患者卵巢功能的影响

目的评价子宫动脉平阳霉素碘油乳剂栓塞对子宫腺肌病患者卵巢功能的影响。方法对33例子宫腺肌病患者用平阳霉素碘油乳剂进行子宫动脉栓塞,并检测栓塞前和栓塞后第1、3、6和12个月的患者以及45例正常体检女性(对照组)同期血中的雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)和催乳素(PRL)水平,其后对两组结果作比较研究。结果栓塞前33例患者的FSH、LH、E2水平与正常对照组差异无显著性(P>0.05),而PRL水平高于正常对照组(P<0.05);栓塞术后1、3、6和12个月的患者FSH、LH、E2皆与术前无显著性差异(P>0.05),但PRL水平较栓塞前明显下降(P<0.05)。结论子宫动脉平阳霉素碘乳剂栓塞治疗子宫腺肌病并不影响患者的卵巢功能,且有利于降低患者的PRL水平。     

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.     

Leiomyoma recurrence after uterine artery embolization

PURPOSE: The purpose of this study was to evaluate the rate of leiomyoma recurrence after uterine artery embolization (UAE) for symptomatic uterine leiomyomas. MATERIALS AND METHODS: A prospective study of UAE of uterine leiomyomas has been ongoing at the authors' hospital since 1997. The recurrence rate was assessed in June 2002. Vascular access was obtained via the right common femoral artery and free-flow embolization was performed with use of 150-250- micro m polyvinyl alcohol particles and an absorbable particle sponge. Follow-up included clinical and ultrasound (US) examinations at 3, 6, and 12 months, and once per year thereafter. RESULTS: Eighty-five UAE procedures were performed between January 1997 and June 2000. Five patients were lost to follow-up. Median follow-up was 30 months (range, 2-57 months). There were six immediate failures: one technical failure, three cases of concomitant disease (one case of endometrial cancer and two cases of adenomyosis), and two cases of large subserosal leiomyomas. There were eight late failures or recurrences: one case of leiomyoma progression, seven cases of new leiomyomas. Mean time to recurrence was 27.4 months. CONCLUSIONS: Although UAE is an effective primary treatment for leiomyomas, this study recorded a recurrence rate of 10% at just more than 2 years. Clinical and US examinations are needed before UAE to exclude pedunculated submucosal leiomyomas and cancers, and must be repeated for more than 2 years after UAE to monitor patients' progress. Longer follow-up and more events are needed to define risk factors for recurrence.     

Uterine artery embolization for symptomatic adenomyosis with or without uterine leiomyomas with the use of calibrated tris-acryl gelatin microspheres: midterm clinical and MR imaging follow-up

PURPOSE: To evaluate clinical and magnetic resonance (MR) imaging results after uterine artery embolization (UAE) in women with symptomatic adenomyosis with or without uterine leiomyomas. MATERIALS AND METHODS: Thirty-eight women with symptomatic adenomyosis with or without uterine leiomyomas were treated with UAE with calibrated tris-acryl gelatin microspheres. Based on MR findings, women were categorized as having pure adenomyosis (group A; n = 15), adenomyosis dominance with fibroid tumors (group B; n = 14), or fibroid tumor dominance with adenomyosis (group C; n = 9). RESULTS: Heavy menstrual bleeding, pain, and bulk-related symptoms at last follow-up at a median of 16.5 months (range, 3-38 months) were compared with baseline symptoms. With follow-up MR imaging at a median of 12 months (range, 3-36 months), changes in uterine volume, leiomyoma volume, junctional zone thickness, and contrast enhancement of adenomyosis were assessed. After embolization, adenomyosis infarction could be depicted on contrast medium-enhanced MR in 44.1% of cases. Median reductions of uterine volume, fibroid tumor volume, and junctional zone thickness were 44.8%, 77.1%, and 23.9%, respectively. In group A, three patients needed additional surgery after UAE, in addition to two in group B and one in group C. In the remaining 32 patients, except for one patient in group C, all preexisting symptoms (eg, bleeding, pain, bulk-related symptoms) improved or resolved after UAE. Overall, 84.2% of women were satisfied with the results of UAE. CONCLUSION: In this study, midterm results (at a median of 16.5 months) showed that UAE in symptomatic adenomyosis with or without uterine leiomyomas is effective. Hysterectomy was avoided in the vast majority of patients. MR imaging showed reduction of uterine volume and junctional zone thickness.     

Uterine arterial embolization for leiomyomas: perfusion and volume changes at MR imaging and relation to clinical outcome

PURPOSE: To monitor changes in perfusion and volume of uterus and leiomyomas after bilateral uterine artery embolization (UAE) and to correlate immediate perfusion changes with subsequent reduction in leiomyoma volume and clinical outcome. MATERIALS AND METHODS: Eleven consecutive women underwent magnetic resonance (MR) imaging before UAE, immediately after, and at 1 and 4 months. Reduction in maximal enhancement above baseline at 90 seconds (ME(90)) after injection of the dominant leiomyoma immediately after embolization was correlated with its volume reduction at 4 months and with clinical response at 12 months. RESULTS: Forty-five leiomyomas were noted (mean, four per patient). Myometrium enhanced briskly (ME(90) of 110%), with a reduction in ME(90) to 26% immediately after embolization. Initial leiomyoma ME(90) was lower (P <.001), but it suppressed to baseline levels immediately after embolization. At 1 and 4 months, myometrial perfusion returned to normal, but leiomyoma perfusion remained suppressed (P <.001). Immediate reduction in leiomyoma ME(90) correlated with clinical response (Spearman rho = 0.64). Leiomyomas initially high in SI on T2-weighted images showed significantly greater volume reduction than those low in SI (P =.006). Well-perfused leiomyomas did not show greater volume reduction than those that were poorly perfused. Volume reduction did not correlate with improvement in clinical symptom score. CONCLUSION: Immediate reduction in leiomyoma perfusion after bilateral UAE correlates with clinical response, whereas leiomyomas initially high in SI on T2-weighted images indicate a likely greater volume reduction.     

Ovarian function after uterine artery embolization for leiomyomata: assessment with use of serum follicle stimulating hormone assay

PURPOSE: To determine if uterine artery embolization (UAE) for leiomyomata causes a change in ovarian function as measured by serial basal follicle stimulating hormone (FSH) assay. MATERIALS AND METHODS: Sixty-three patients undergoing UAE for symptomatic leiomyomata had blood samples obtained on day 3 of a menstrual cycle before UAE and on day 3 during menstrual cycles 3 and 6 months after treatment. Analysis of variance was used to detect differences in FSH levels among age groups at each interval. Repeated measures analysis of variance was used to determine if individual mean change occurred for the group as a whole and for each age group. Onset of new menopausal symptoms was compared between groups with use of the chi(2) test. RESULTS: There was no significant change in basal FSH levels for the group as a whole (P =.16), but there was a statistically significant difference when age groups were compared (P =.03). Individual change of >2 SD from baseline mean FSH level occurred at 6 months in seven patients, all 45-50 years of age. Four of these patients (15% of patients over age 44) had FSH levels increase to more than 20 IU/L. chi(2) analysis did not reveal any difference among the groups studied in the onset of menopausal symptoms. CONCLUSIONS: Most patients had no change in ovarian function as measured by basal FSH after UAE. For patients aged 45 or older, there is approximately a 15% chance of an increase in basal FSH into the perimenopausal range.