选择性子宫动脉栓塞治疗症状性子宫肌瘤

目的：探讨和评价选择性子宫动脉栓塞治疗症状性子宫肌瘤的有效性和安全性，材料和方法：对12例症状性子宫肌瘤患者进行选择性子宫动脉栓塞治疗，于术后3－8天，1月、3－8月随访，观察瘤体内栓塞沉积情况，坏死范围，肿瘤体积变化及 症状缓解情况。结果：所有病例均栓塞成功，术后3－8天CT扫描示：栓塞剂在肌瘤内沉积良好，1月，瘤体内出现明显坏死；3－8月，肌瘤体积缩小大于60％者21例（65．63％），30－60％者7例（21．87％），小于30％者2例（6．25％），1例无效，1例术后15天行子宫切除，随访期内28例临床症状完全消失，2例症状减轻，1例症状无变化，结论：选择性子宫动脉栓塞治疗症状性子宫肌瘤疗效确切，术程安全，远期效果及复发率需进一步观察。     

子宫肌瘤介入栓塞治疗34例分析

目的 评价经导管子宫动脉栓塞治疗子宫肌瘤的疗效。方法 34例子宫肌瘤患均采用超选择性双侧子宫动脉插管方法，注射聚乙烯醇（PVA）和明胶海绵栓塞。结果 所有病例随访1－15个月（平均6个月），总的症状改善率91．2％（31／34），表现为月经增多症状均有不同程度改善，下腹部胀痛消失，栓塞后肌瘤均有缩小，B提示瘤体缩小1／3或以上达79．4％（27／34）。结论 子宫动脉栓塞治疗子宫肌瘤病是一种安全、有效的治疗方法。     

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。     

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。     

介入治疗子宫肌瘤的临床应用

目的 探讨子宫动脉栓塞术治疗子宫肌瘤的疗效观察。方法 对152例子宫肌瘤患者进行选择性子宫动脉栓塞治疗。结果 栓塞双侧子宫动脉145例，单侧7例.131例完整随访者术后6个月子宫体积平均缩小43．6％，21例肌瘤消失，127例肌瘤体积平均缩小68．2％，肌瘤缩小程度随时间延长而显著。结论 通过子宫动脉栓塞术介入治疗子宫肌瘤是治疗子宫肌瘤的有效方法。     

用平阳霉素碘油乳剂栓塞子宫动脉在子宫肌瘤介入治疗中的临床评价

目的：分析评价平阳霉素碘油乳剂子宫动脉灌注在子宫肌瘤像介入治疗中的临床疗效。方法：对20例子宫肌瘤患者经子宫动脉灌注PLE随访2－12个月观察。结果：子宫体积（含瘤体）缩小30％－50％,临床症状明显改善,结论：使用平阳霉素碘油乳剂栓塞子宫动脉疗子宫肌瘤是有效的。     

海藻酸钠微球颗粒子宫动脉栓塞治疗子宫肌瘤的疗效分析

目的:探讨应用海藻酸钠微球颗粒(KMG)行子宫动脉栓塞术治疗子宫肌瘤的疗效。方法:35例子宫肌瘤患者接受子宫动脉栓塞治疗。子宫动脉栓塞方法为经导管双侧子宫动脉注入KMG,栓塞后随访复查,随访时间全部为6个月以上,观察子宫肌瘤的缩小及临床症状改善情况。结果:35例全部完成双侧超选择子宫动脉插管,技术成功率为100%。在有症状的29例中,25例(86.2%)症状有不同程度改善,其中月经症状改善最为显著。至栓塞后6个月时,肌瘤体积平均缩小49.3%,子宫体积平均缩小42.1%,所有患者随访期内肌瘤缩小后未再增大。术后最常见副反应即栓塞后综合征,所有病例随访期内均未出现其他严重副反应或并发症。结论:应用KMG行子宫动脉栓塞术是一种有效、可靠的治疗子宫肌瘤的治疗方法。     

经导管子宫动脉栓塞治疗子宫肌瘤的疗效及安全性评价

目的 探讨经导管子宫动脉椎塞（TUAE）治疗子宫肌瘤的疗效及安全性。方法 38例子宫肌瘤患者行经导管子宫动脉注射碘油平阳霉素乳剂栓塞治疗,其中5例于栓塞后1－3周行全宫切除或肌瘤剔除术,标本送病栓。另33例随访3－6个月,主要观察症状改善及肌瘤大小与子宫体积变化。结果 总的症状改善率90.6%（39／32％）,其中月经完全恢复正常点90.3%（28／31）,下腹部、腰腿胀痛消失占83.3%（25／30）,尿频、尿急等压迫症状消失占45.57%（5／11）。肌瘤体积平均缩小61.3%,子宫体积平均缩小50.6%,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异常。TUAE后未见严重并发症发生。结论 TAUE治疗子宫肌瘤具有明显的近期疗效,而且是一项安全的治疗方法。     

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。     

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。     

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。     

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.     

双侧子宫动脉栓塞治疗产后大出血

目的探讨双侧子宫动脉栓塞治疗产后大出血的疗效与安全性。方法用明胶海绵对6例产后大出血患者行双侧子宫动脉栓塞。结果治疗后子宫出血症状明显改善,术后随访6个月,未出现严重并发症。结论双侧子宫动脉栓塞治疗产后大出血是一种安全、有效的方法。     

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.     

栓塞子宫动脉治疗症状性子宫肌瘤的探讨

目的探讨运用无水酒精超液化碘化油乳剂栓塞子宫动脉治疗症状性子宫肌瘤的临床疗效。方法症状性子宫肌瘤患者均采用经皮股动脉穿刺,双侧子宫动脉插管,超选择至双侧子宫动脉远端,用无水酒精超液化碘化油乳剂栓塞。结果2例病人手术未成功,28例病人取得了手术成功。其中20例病人进行术后追综随访,18例取得了不同程度的显著的临床疗效,2例效不明显,8例失随访。一例病人单侧子宫动脉供血,栓塞后疗效较差。结论无水酒精超液态碘化油乳剂选择性子宫动脉栓塞为非手术治疗症状性子宫肌瘤的较好方法。     

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。     

Spectrum of imaging findings on MRI and CT after uterine artery embolization

Uterine artery embolization (UAE) is an effective treatment for symptomatic uterine fibroids. Magnetic resonance (MR) imaging is typically employed to evaluate the uterus following UAE for fibroid infarction, size, location change, persistent enhancement, changes in adenomyosis, and uterine necrosis. Variable pattern of calcification on computed tomography (CT) can differentiate embolic particles and fibroid involution. CT following UAE may be requested because of acute pelvic pain or chest discomfort or pyrexia and/or for complications that may require treatment in acute phase. Visualization of gas in uterus and uterine vessels following UAE is an expected finding that should not be misinterpreted as a sign of infection. The MRI and CT appearances vary depending upon the time interval after UAE and success of the procedure. Radiologists should be familiar with the range of post-UAE appearances on MRI and CT to better aid clinicians in correct diagnosis and treatment. The main purpose of this pictorial review is to identify the spectrum of findings on MRI and CT performed after UAE, to illustrate UAE-associated common and uncommon MRI and CT appearances and discuss post-UAE complications that require urgent medical or surgical intervention.     

急诊子宫动脉栓塞术治疗子宫切口妊娠大出血

目的探讨急诊行子宫动脉灌注药物栓塞术治疗剖宫产后切口妊娠的可行性和临床价值。方法 2009年10月-2011年12月,对17例临床证实切口瘢痕妊娠并阴道出血患者,急诊行双侧子宫动脉灌注甲氨蝶呤并超选择栓塞术,术后通过观察人绒毛膜促性腺激素（HCG）水平、阴道出血及术后清宫术来评价疗效。结果 17例患者急诊行子宫动脉灌注栓塞术成功,术后阴道出血均停止或减少,HCG水平均明显下降,3例因孕囊自行排除而未行清宫,14例术后2～4 d行胚胎钳刮术,术中出血量较少。所有患者1周后均治愈出院。结论子宫动脉灌注栓塞术是治疗剖宫产术后切口瘢痕妊娠的一种有效方法,可及时治疗阴道大出血,促进杀胚,并为术后清宫提供安全保障。