子宫动脉栓塞治疗子宫腺肌病80例疗效分析

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80例子宫腺肌病患者行子宫动脉栓塞术。术后随访3、6、12、24个月观察患者痛经程度变化,月经量及子宫体积变化。结果子宫动脉栓塞术后,80例患者临床症状全部缓解,月经量明显减少,贫血改善;子宫体积和病灶体积均明显缩小;卵巢内分泌功能无明显影响。其中76例术后1个月痛经症状完全消失,4例术后4个月痛经症状完全消失。结论子宫动脉栓塞术是一种微创、安全、不良反应少的治疗方法,临床疗效显著,能明显改善患者生活质量。     

子宫腺肌病介入治疗39例近期疗效分析

目的　探讨子宫动脉栓塞术治疗子宫腺肌病的疗效。方法　采用Seldinger技术,对39例确诊为子宫腺肌病的患者(其中11例为子宫腺肌病合并子宫肌瘤)行双侧子宫动脉栓塞术,术后观察月经量、痛经程度、贫血及子宫、病灶体积的变化情况。结果　治疗后6个月,月经量平均减少56. 2% (Ρ<0. 01);痛经症状明显缓解3例(7. 7% ),消失36例(92. 3% ),有效率为100%;所有贫血病例Hb恢复到正常值(100% );子宫体积平均缩小41. 3% (Ρ<0. 01),病灶明显缩小或消失;超声检查显示子宫肌层及病灶血流信号明显减少。结论　子宫动脉栓塞术治疗子宫腺肌病近期疗效优良,症状改善显著,远期疗效有待观察。     

选择性子宫动脉栓塞治疗子宫腺肌病的临床研究

目的 :研究选择性子宫动脉栓塞 (UAE)治疗子宫腺肌病的临床效果。方法 :对 2 5例经临床、超声或MRI诊断为子宫腺肌病的患者行UAE。采用Seldinger技术经股动脉穿刺 ,将导管选择性插入双侧子宫动脉 ,经导管注入真丝线段和明胶海绵微粒栓塞 ,阻断异位内膜病灶血供。术后观察月经量、痛经程度及子宫、病灶体积等变化。结果 :所有病例随访 3～ 12个月 (平均 8个月 ) ,临床症状缓解率 96%。月经量均恢复正常。 2 0例患者术后痛经完全消失 ,4例明显缓解 ,1例复发 ;栓塞后 6个月 ,子宫体积平均缩小 48.4% ,14个腺肌瘤体积平均缩小 47.1% ;超声检查子宫肌层及病灶内血流信号明显减少。无严重并发症发生。结论 :UAE治疗子宫腺肌病是一种安全、近期疗效显著的方法 ,远期疗效尚需进一步观察。     

子宫动脉栓塞对子宫腺肌病的治疗效果

目的评价子宫动脉栓塞术对子宫腺肌病的疗效。方法对30例经超声和磁共振成像证实的子宫腺肌病患者行子宫动脉栓塞治疗,栓塞后随访评价临床症状改善情况。结果30例患者行子宫动脉栓塞治疗后28例痛经完全缓解,2例明显缓解。术后29例患者月经量较术前明显减少,月经周期无明显改变,未出现严重并发症。结论子宫动脉栓塞治疗子宫腺肌病疗效显著,可作为该病的常规治疗方法之一。     

子宫动脉栓塞治疗子宫腺肌病的临床研究

目的：探讨子宫动脉栓塞(UAE)治疗子宫腺肌病的临床价值。方法：对21例子宫腺肌病的妇女进行单侧股动脉穿刺插管达双侧子宫动脉，用超液化碘油 平阳霉素乳化后栓塞，再用明胶海绵栓塞子宫动脉主干。术后观察病人的痛经程度、月经量及子宫体积变化。结果：术后随访半年以上的18例，痛经完全缓解的14例，完全缓解率达77％，15例月经完全恢复正常；术后3月子宫体积明显缩小；4例合并卵巢子宫内膜异位症包块有不同程度的缩小。结论：平阳霉素 明胶海绵行UAE治疗子宫腺肌病是一种创伤小、临床疗效显著的方法。     

子宫动脉甲氨蝶呤灌注和栓塞治疗子宫腺肌病

目的探讨DSA引导下经导管子宫动脉内灌注甲氨蝶呤结合子宫动脉栓塞治疗不同类型子宫腺肌病的临床疗效。方法对33例根据临床症状、彩色B超初筛,在Seldinger方法完成子宫动脉超选择性插管造影,证实为弥漫型子宫腺肌病和局灶型子宫肌腺病的患者,用MTX50mg子宫动脉局部灌注,并加用PVA微球颗粒(直径350～560μm)栓塞治疗。比较两组病例月经量、痛经程度、子宫体积及性激素水平等的术后变化及两组间是否存在差异。结果MTX局部灌注结合子宫动脉栓塞术,无化疗药物不良反应;经治疗的全部病例,月经量减少,痛经程度减轻。弥漫型子宫肌腺病子宫体积进行性缩小,与局灶型子宫腺肌病比较,疗效更为显著(P<0.05)。结论微创介入技术和药物相结合的方法可用于弥漫型子宫腺肌病和局灶型子宫腺肌病的治疗,尤其适宜于弥漫型子宫腺肌病。     

子宫动脉栓塞术治疗子宫腺肌病临床观察

目的 探讨经导管子宫动脉栓塞术治疗子宫腺肌病的临床效果。方法 选择15例子宫腺肌病患者，采用Seldinger技术行双侧子宫动脉插管，造影确诊后注入携带有抗生素的聚乙烯醇(PVA)栓塞颗粒进行栓塞，术后l、3、6、12个月观察其疗效。结果 子宫动脉栓塞治疗后，月经恢复正常，贫血症状改善；子宫、病灶体积缩小显著；14例患者术后3个月内痛经消失，1例明显缓解；彩超示病灶内血流信号明显减少。结论 子宫动脉栓塞治疗子宫腺肌病是一种微创、疗效显著的治疗方法。     

子宫动脉栓塞术治疗子宫腺肌病的近期疗效观察

目的 探讨子宫动脉栓塞术治疗子宫腺肌病的近期临床效果.方法 对我院18例经MRI诊断为子宫腺肌病的患者行子宫动脉栓塞术,采用Seldinger技术经股动脉穿刺,将导管选择性插入双侧子宫动脉,应用PVA(500～700μm)与碘佛醇混匀后在透视下经导管缓慢推注将子宫动脉栓塞.阻断异位内膜病灶血供,术后定期复查磁共振观察病灶体积及信号等变化.对所有患者随访至术后2月.结果 治疗后11例患者痛经完全缓解消失,6例明显缓解,1例变化不明显;子宫体积由治疗前的(208.5±70.9) cm3,缩小至治疗后的(176.7±57.2)cm3(P＜0.01).结论 子宫动脉栓塞术能有效缓解子宫腺肌病患者痛经程度、缩小子宫体积,是一种安全、有效的治疗方法.     

病灶切除术联合药物治疗子宫腺肌病56例临床疗效分析

目的：探讨病灶切除术及药物联合治疗子宫腺肌病的可行性及安全性。方法分析2010年1月－2015年1月56例子宫腺肌病患者行开腹或腹腔镜子宫腺肌病病灶切除术的临床资料。结果术后6个月的随访中,经治疗后91.1％的患者痛经症状改善,月经量均减少;术中出血量腹腔镜手术明显少于开腹手术;两者间差异有统计学意义（ P＜0.05）;手术联合Gn-RH－α组治疗后痛经缓解消失比例明显高于另外两组（ P＜0.05）;12例不孕症患者,术后7例妊娠。结论大多数子宫腺肌病患者可通过子宫腺肌病病灶切除术,达到缓解痛经及月经量过多的症状,术后辅助药物治疗能有效控制症状,减轻疾病复发,提高妊娠率。     

不同栓塞剂栓塞子宫动脉治疗子宫腺肌症的中远期随访分析

目的探讨应用不同栓塞剂栓塞子宫动脉治疗子宫腺肌症的临床疗效和并发症的发生情况。方法回顾性分析2004—2011年分别以国产碘化油、海藻酸钠微球和Embosphere微球栓塞子宫动脉治疗的子宫腺肌症患者45例,其痛经等症状变化、子宫磁共振影像改变及临床严重并发症的发生情况进行了为期2年以上的随访。结果术后3组患者痛经程度、月经量等临床症状均有改善,6个月时碘化油组、海藻酸钠微球组和Embosphere微球组痛经明显缓解率分别为33.3%(5/15),30.8%(4/13),41.1%(7/17);12个月时MRI显示子宫体积分别缩小为49.19%、48.25%和50.05%;24个月时有8例患者痛经复发,分别为碘化油组2例,海藻酸钠微球组4例和Embosphere微球组2例。碘化油组发生闭经2例,Embosphere微球组发生闭经1例。结论以碘化油、海藻酸钠微球或Embosphere微球进行超选择性子宫动脉栓塞治疗子宫腺肌症对缓解患者痛经程度、缩小子宫体积具有良好的效果;栓塞治疗发生闭经的原因除卵巢功能减退外,也可能为子宫宫腔粘连;在取得临床疗效相似的情况下,使用颗粒型固体栓塞剂进行栓塞治疗其安全性可能较液体栓塞剂为高。     

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 artery embolization for adenomyosis without fibroids

AIM: To evaluate the potential usefulness of transcatheter uterine artery embolization as a treatment for symptomatic adenomyosis in patients without uterine fibroids. MATERIALS AND METHODS: Uterine artery embolization using polyvinyl alcohol particles sized 250-710 mm was performed in 43 patients (mean; 40.3 years, range; 31-52 years) with dysmenorrhoea, menorrhagia, or bulk-related symptoms (pelvic heaviness, urinary frequency) due to adenomyosis without fibroids. All patients underwent pre-procedural and 3.5 months (range 1-8 months) follow-up magnetic resonance imaging (MRI) with contrast enhancement. Clinical symptoms were also assessed at the time of MRI before and after embolization. RESULTS: Significant improvement of dysmenorrhoea (95.2%) and menorrhagia (95.0%) was reported in most patients. Contrast-enhanced MRI revealed non-enhancing areas suggesting coagulation necrosis of adenomyosis in 31 patients (72.1%), decreased size without necrosis in 11 patients (25.6%), and no change in one patient (2.3%). The mean volume reduction of the uteri after uterine artery embolization was 32.5% (from 321.7+/-142.9 to 216.7+/-130.1 cm(3)). CONCLUSION: Transcatheter uterine artery embolization is an effective therapy for the treatment of symptomatic pure adenomyosis, and may be a valuable alternative to hysterectomy.     

Uterine artery embolization for the treatment of adenomyosis: clinical response and evaluation with MR imaging.

OBJECTIVE: This study was performed to evaluate the MR imaging appearance and clinical response of patients undergoing uterine artery embolization for the treatment of menorrhagia due to adenomyosis. MATERIALS AND METHODS: A retrospective review of 15 patients with adenomyosis and menorrhagia who underwent uterine artery embolization was performed. The diagnosis of adenomyosis was based on established MR imaging criteria. Clinical response was assessed at a minimum of 3 months after embolization. Follow-up MR imaging was performed 6 months after embolization. RESULTS: Of the 15 patients in this study, five had diffuse adenomyosis without evidence of uterine fibroids, one had focal adenomyosis without evidence of uterine fibroids, and the remaining nine had adenomyosis with one or more fibroids. At follow-up, 12 (92.3%) of the 13 patients reported significant improvement in presenting symptoms and quality of life. One patient continued experiencing menorrhagia, and one patient experienced amenorrhea during the 5 months of follow-up after embolization. MR imaging in nine patients, performed at a mean of 5.9 months after embolization, revealed significant reductions in median uterine volume (42%), median fibroid volume (71%), and mean-junctional-zone thickness (11 mm; 33%; p < 0.5). Six of the nine patients had subendometrial regions of decreased T2 signal intensity after embolization. CONCLUSION: Uterine artery embolization is a promising nonsurgical alternative for patients with menorrhagia and adenomyosis. Significant improvement in presenting symptoms and in quality of life is associated with decreases in uterine size and junctional zone thickness. Larger prospective studies are needed to establish the safety and efficacy of this procedure for patients with adenomyosis.     

影响子宫肌瘤栓塞治疗的因素

目的观察子宫动脉栓塞术(UAE)对子宫肌瘤的治疗效果,并分析影响疗效的因素。方法46例症状性子宫肌瘤患者经超选择性插管双侧子宫动脉内注入PVA微粒栓塞治疗,术后6、9个月随访复查,观察临床症状改善,肌瘤体积变化情况,并对临床上治疗效果与多种不同的影响因素进行分析。结果UAE术后临床症状改善,尤其以子宫出血症状改善最为明显,栓塞后6个月肌瘤体积平均缩小45.6%,9个月肌瘤体积平均缩小58.4%。盆腔内血管解剖、内分泌、栓塞技术及肌瘤类型等因素影响子宫肌瘤栓塞后的疗效。结论双侧子宫动脉栓塞治疗子宫肌瘤是一种安全、有效的方法,其疗效与盆腔内血管解剖、内分泌、栓塞技术及肌瘤类型等多种因素有关。     

动脉栓塞治疗子宫肌瘤

目的观察动脉栓塞治疗子宫肌瘤的临床效果.方法采用Seldinger方法动脉栓塞治疗86例子宫肌瘤患者.经股动脉穿刺,将导管选择性插入双侧子宫动脉,经导管注入PVA和平阳霉素,阻断肌瘤血供.动脉栓塞6个月后对患者的临床症状和超声检查结果进行分析,同时还分析了该方法的并发症和失败原因.结果经血管造影发现,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,治疗后6个月的随访结果表明月经量及月经周期恢复正常,疼痛明显改善,肌瘤和子宫明显缩小.临床有效率91%.结论动脉栓塞治疗子宫肌瘤是一种创伤小,临床治疗效果好的新方法.     

子宫动脉栓塞术治疗子宫肌瘤临床研究

目的　研究平阳霉素碘化油乳剂经子宫动脉栓塞治疗子宫肌瘤的疗效、安全性和不良反应。方法　对 15 8例子宫肌瘤患者进行超选择性子宫动脉栓塞治疗 ,所用材料为平阳霉素碘化油乳剂及明胶海绵颗粒。术后随访 3～ 18个月 ,观察栓塞术后子宫大小与肌瘤体积的变化及不良反应。结果　 15 0例行双侧子宫动脉栓塞 ,8例完成单侧栓塞。术中造影显示子宫动脉明显增粗 ,肌瘤滋养血管呈螺旋状 ,肌瘤染色明显 ,排空延迟。 6例术后 1周行子宫切除术 ,手术标本病理观察肌瘤呈点片状坏死 ,小出血点。随访 3个月 ,症状缓解率达 90 .5 %。其中子宫出血症状完全消失者占 89.4 % ,盆腔胀痛及腹胀等压迫症状消失占 91.3% ,肌瘤体积平均缩小 80 % ,子宫体缩小 4 8%。结论　早期结果表明 ,平阳霉素碘油乳剂子宫动脉栓塞治疗子宫肌瘤疗法安全有效 ,并发症发生率低 ,是子宫肌瘤的较好治疗方法