子宫动脉栓塞治疗子宫肌瘤的疗效和并发症分析

目的　探讨选择性子宫动脉栓塞治疗子宫肌瘤的临床疗效和并发症的发生情况。方法　 2 0 0 0年 10月～ 2 0 0 2年 5月选择 4 0例子宫肌瘤患者用PVA颗粒做栓塞剂行子宫动脉栓塞 ,栓塞后定期评价临床疗效和并发症 ,彩超监测子宫和最大肌瘤体积。根据SCVIR制订的并发症分级系统 ,评价并发症的严重性。结果　4 0例患者行子宫动脉栓塞 ,平均随访 18 9个月 ,97%临床症状改善。子宫和最大肌瘤体积平均缩小 4 3 8%和6 3 5 %。栓塞前子宫和最大肌瘤体积的中位数为 2 4 3 4cm3和 14 8cm3,栓塞后 6个月中位数为 10 7 1cm3和4 1 1cm3,(P <0 0 0 1)。 88 5 %的并发症为A、B级 ,1例 (2 5 % )D级并发症为阴道排瘤继发感染再入院治疗。7例 (17 5 % )较严重的栓塞后综合征。 1例 (2 5 % ) 2年后复发。 4例 (10 0 % )卵巢功能衰竭 ,发生在栓塞后2～ 18个月。 2 0例 (5 0 0 % )患者阴道排液。 92 5 %患者对治疗的结局表示满意。结论　子宫动脉栓塞治疗子宫肌瘤能有效的改善症状 ,缩小瘤体 ,失败率低 ,严重并发症少。术前严格选择适应症 ,术后预防感染是降低并发症的关键。     

Uterine artery embolisation for the treatment of symptomatic uterine fibroids: short-term results of work in progress

Bilateral uterine artery embolisation (UAE) was used to treat 11 women with symptomatic uterine fibroids. Uterine volume and dominant fibroid volume were assessed quantitatively by ultrasonography both before and at two and six months post procedure. Both uterine arteries were occluded effectively in all of the women, and the procedure was well tolerated, with hospital stays limited to 24-48 hours in all cases. An improvement of symptoms occurred in 10 of the 11 women. There were no significant complications. The mean percentage reductions in uterine volume and dominant fibroid volume at six months following the procedure were 45.32% and 56.34%, respectively. Bilateral uterine artery embolisation for the treatment of uterine fibroids is a minimally invasive technique with very good clinical results. This procedure may be considered as an alternative to hysterectomy, or myomectomy in properly selected cases.     

Long-term follow-up of patients with uterine fibroids after treatment with the LHRH agonist buserelin

Ten patients with uterine fibroids palpable abdominally were treated with the luteinizing hormone-releasing hormone (LHRH) agonist buserelin, administered intransally, 300 micrograms three times daily, for 6 months, and were then followed for a further 12 months. Oestrogen levels were markedly reduced in all patients during treatment. At the end of treatment the mean volume reductions were 44.4% (SEM 3.5) for total uterine volume and 57.3% (SEM 7.4) for volume of discrete fibroids as assessed ultrasonically. There was also marked improvement in associated symptoms. After buserelin therapy was stopped, the total uterine and discrete fibroid volumes returned to, or slightly exceeded, pretreatment volumes within 6 months in five patients, and by 12 months in two patients. Three other patients who underwent surgery for their fibroids during the first 4 months after treatment showed regrowth of fibroids to pretreatment size. Four comparable asymptomatic untreated patients showed no significant change in the total uterine or fibroid volume during six monthly ultrasonic assessments. Buserelin therapy may facilitate rather than replace surgery in the management of uterine fibroids.     

Long-term follow-up of patients with uterine fibroids after treatment with the LHRH agonist buserelin

Summary. Ten patients with uterine fibroids palpable abdominally were treated with the luteinizing hormone-releasing hormone (LHRH) agonist buserelin, administered intransally, 300 μg three times daily, for 6 months, and were then followed for a further 12 months. Oestrogen levels were markedly reduced in all patients during treatment. At the end of treatment the mean volume reductions were 44·4% (SEM 3·5) for total uterine volume and 57·3% (SEM 7·4) for volume of discrete fibroids as assessed ultrasonically. There was also marked improvement in associated symptoms. After buserelin therapy was stopped, the total uterine and discrete fibroid volumes returned to, or slightly exceeded, pretreatment volumes within 6 months in five patients, and by 12 months in two patients. Three other patients who underwent surgery for their fibroids during the first 4 months after treatment showed regrowth of fibroids to pretreatment size, Four comparable asymptomtic untreated patients showed no significant change in the total uterine or fibroid volume during six monthly ultrasonic assessments. Buserelin therapy may facilitate rather than replace surgery in the management of uterine fibroids.     

Transcervical,intrauterine ultrasound-guided radiofrequency ablation of uterine fibroids with the VizAblate® System: three- and six-month endpoint results from the FAST-EU study

This was a prospective, longitudinal, multicenter, single-arm controlled trial, using independent core laboratory validation of MRI results, to establish the effectiveness and confirm the safety of the VizAblate® System in the treatment of symptomatic uterine fibroids. The VizAblate System is a transcervical device that ablates fibroids with radiofrequency energy, guided by a built-in intrauterine ultrasound probe. Fifty consecutive women with symptomatic uterine fibroids received treatment with the VizAblate System. Patients had a minimum Menstrual Pictogram score of 120, no desire for fertility, and met additional inclusion and exclusion criteria. The VizAblate System was inserted transcervically and individual fibroids were ablated with radiofrequency energy. An integrated intrauterine ultrasound probe was used for fibroid imaging and targeting. Anesthesia was at the discretion of each investigator. The primary study endpoint was the percentage change in perfused fibroid volume, as assessed by contrast-enhanced MRI at 3 months. Secondary endpoints, reached at 6 months, included safety, percentage reductions in the Menstrual Pictogram (MP) score and the Symptom Severity Score (SSS) subscale of the Uterine Fibroid Symptom-Quality of Life questionnaire (UFS-QOL), along with the rate of surgical reintervention for abnormal uterine bleeding and the mean number of days to return to normal activity. Additional assessments included the Health-Related Quality of Life (HRQOL) subscale of the UFS-QOL, medical reintervention for abnormal uterine bleeding, and procedure times. Fifty patients were treated, representing 92 fibroids. Perfused fibroid volumes were reduced at 3 months by an average of 68.8?±?27.8 % (P?<?0.0001; Wilcoxon signed-rank test). At 6 months, mean MP and SSS scores decreased by 60.8?±?38.2 and 59.7?±?30.4 %, respectively; the mean HRQOL score increased by 263?±?468 %. There were two serious adverse events (overnight admissions for abdominal pain and bradycardia, respectively) and no surgical reinterventions. These 6-month results suggest that the VizAblate System is safe and effective in providing relief of abnormal uterine bleeding associated with fibroids, with appropriate safety and a low reintervention rate.     

Non-invasive magnetic resonance imaging-guided focused ultrasound treatment for uterine fibroids – early experience

Objective

To describe early results regarding efficacy and safety of magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) for the treatment of uterine leiomyomas among a population of Japanese women.

Study design

In this single site study, 48 Japanese women, over 18 years of age, who were candidates for surgical intervention due to symptomatic fibroids, were recruited. Fifty-five uterine fibroids were treated by MRgFUS and followed up for 12 months.

Results

During the 12-month follow-up period, two patients (4%) required surgical interventions, and two patients required additional drug treatment for fibroids. The average reduction in fibroid volume determined by MR imaging at 6 months after treatment was 33%. This volume reduction is correlated with the fibroid's treated volume. No serious complications were recorded during the treatments or follow-up period.

Conclusion

MRgFUS can safely be used to non-invasively treat symptomatic uterine fibroids and avoid the need for surgical intervention in the short term. With large treatment volumes, MRgFUS also results in significant fibroid shrinkage in a relatively short time. Additional follow-up is needed to determine the long-term durability of this promising non-invasive approach.     

Uterine artery embolization for the treatment of uterine fibroids: An outpatient procedure

OBJECTIVE: Our objectives were to establish an outpatient program for uterine artery embolization of fibroids and to monitor the following: percentage of patients who required immediate hospitalization or admission within 2 weeks, outcomes in terms of the degree of ultrasound regression of the fibroids, patient satisfaction, reduction of pressure symptoms, and reduction of bleeding. STUDY DESIGN: Patients were screened by a gynecologist with the use of a designed care algorithm; they then underwent uterine embolization, performed by an interventional radiologist. Patients were evaluated at 6 weeks and 6 months after the procedure, and ultrasound studies were performed both before and at 2 to 6 months after the procedure. RESULTS: Of 35 patients, 29 (83%) went home on the day of the procedure, whereas 6 were observed overnight. Three (9%) patients required admission within 1 week. Of 26 patients, 24 (92%) were satisfied with the reduction of bleeding, and 14 of 18 (78%) were satisfied with the reduction in pressure symptoms. The mean decrease in uterine volume was 36%, and the mean decrease in the size of the dominant fibroid was 49%. CONCLUSIONS: Uterine artery embolization for the treatment of uterine fibroids might be done on an outpatient basis with a low rate of same-day admissions and delayed admissions. Patient satisfaction was high, and uterine artery embolization might become an accepted option for the treatment of uterine fibroids.     

The FAST-EU trial: 12-month clinical outcomes of women after intrauterine sonography-guided transcervical radiofrequency ablation of uterine fibroids

The FAST-EU Trial was designed to establish the effectiveness and confirm the safety of transcervical intrauterine sonography-guided radiofrequency ablation with the VizAblate? System in the treatment of symptomatic uterine fibroids. This was a multicenter, prospective, single-arm trial involving academic and community hospitals in the United Kingdom, the Netherlands, and Mexico. Women with qualifying uterine fibroids and heavy menstrual bleeding underwent intrauterine sonography-guided transcervical radiofrequency ablation (RFA) with the VizAblate System; anesthesia was individualized. Patients were required to have up to five fibroids from 1 to 5 cm in diameter. The primary trial endpoint was the percentage change in perfused fibroid volume, as assessed by contrast-enhanced MRI at 3 months by an independent core laboratory. Secondary endpoints, evaluated at 6 and 12 months, included safety, percentage reductions in the Menstrual Pictogram (MP) score, and the Symptom Severity Score (SSS) subscale of the Uterine Fibroid Symptom-Quality of Life (UFS-QOL) questionnaire, along with the rate of surgical reintervention for abnormal uterine bleeding and the mean number of days to return to normal activity. Additional assessments included the Health-Related Quality of Life (HRQOL) subscale of the UFS-QOL, nonsurgical reintervention for abnormal uterine bleeding, anesthesia regimen, patient satisfaction, and pain during the recovery period. An additional MRI study was performed at 12 months on a subgroup of patients. Fifty patients (89 fibroids) underwent transcervical radiofrequency ablation with the VizAblate System. At 3 and 12 months, perfused fibroid volumes were reduced from baseline by an average of 68.1?±?28.6 and 67.4?±?31.9 %, respectively, while total fibroid volumes were reduced from baseline by an average of 54.7?±?37.4 and 66.6?±?32.1 %, respectively (all P?<?.001 compared with baseline; Wilcoxon signed-rank test). At 12 months, mean MP score and SSS decreased by 53.8?±?50.5 and 55.1?±?41.0 %, respectively; the mean HRQOL score increased by 277?±?483 %. There were four surgical reinterventions (8 %) within 12 months. This is the first report of the 12-month follow-up for patients in the FAST-EU Trial. In concert with previously reported 3- and 6-month endpoint data, the 12-month results of the FAST-EU Trial suggest that in addition to substantially reducing the perfused and total volume of targeted uterine fibroids, the VizAblate System is safe and effective through 12 months in providing relief of abnormal uterine bleeding associated with submucous, intramural, and transmural fibroids.     

Uterine artery embolisation for the treatment of symptomatic fibroids in 114 women: reduction in size of the fibroids and women's views of the success of the treatment

Objective To assess the reduction in size of fibroids following uterine artery embolisation and to analyse women's views of the success of treatment.
Design An uncontrolled case series of 114 consecutive women who underwent uterine artery embolisation for the treatment of fibroids over two years.
Setting The Diagnostic and Interventional Radiology Department at The Royal Surrey County Hospital, Guildford, UK.
Methods Bilateral uterine artery embolisation was performed for the treatment of symptomatic fibroids. Magnetic resonance imaging was carried out before and six months following embolisation. Women completed outcome questionnaires following their treatment.
Main outcome measures The sites, imaging signal characteristics and percentage reduction in the volume of three dominant fibroids were determined from the magnetic resonance scans. Outcome was measured by questionnaire. Women were asked whether their symptoms resolved completely, improved, remained unchanged or deteriorated.
Results One hundred and sixty-five fibroids of 114 women (mean age 42) were analysed. Forty-five percent of women had complex fibroid masses and 50% had fibroids ≥8.5cm in diameter. The median reduction in the fibroid volume was 58%. The median reduction of the volume of complex fibroid masses, submucous fibroids, fibroids ≥8.5cm and fibroids with high and low signal on T2 weighted sequences were 58%, 63%, 50%, 62% and 51%, respectively. Ninety-one percent of the women's symptoms had resolved or improved following embolisation.
Discussion The majority of women were satisfied with their outcome. We have shown that uterine artery embolisation is a successful treatment for symptomatic fibroids of all types, sizes and signal characteristics.     

Complications and myoma recurrence after laparoscopic uterine artery occlusion for symptomatic myomas

AIM: To determine the frequency and severity of complications and the recurrence of fibroids as a result of laparoscopic occlusion of the uterine artery (LOUA) in women with symptomatic fibroids. METHODS: One hundred and fourteen women with symptomatic fibroids were treated using ultrasonically activated shears, clips or electrosurgery. A retrospective evaluation of the complications and recurrence rate was carried out. For each patient, the analysis took place at least 3 months after the procedure was performed. Each complication was categorized using the complication classifications developed by the Czech Society of Gynecologic Endoscopy and a modified set of the classifications of the American College of Obstetricians and Gynecologists. All adverse events that occurred during the follow-up period were included, in addition to those that occurred after the 3 months minimum interval. RESULTS: A total of eight women (7.1%, 95% confidence intervals [CI], 3.3-14.4) experienced complications; one of these women had two complications, resulting in a total of nine adverse events. There were no intraoperative complications and no permanent injuries. Two women required supracervical hysterectomy and myomectomy, respectively, as a result of fibroid necrosis. One patient had an undiagnosed endometrial stromal sarcoma after 12 months of LOUA. The rate of fibroid recurrence was 9.0% (10 patients). The recurrence-free survival interval rate (no clinical failure, no recurrence) at 23.6 months (median) follow-up was 88.3% (CI 84.9-93.5). CONCLUSION: The rate of complications and fibroid recurrence was low in patients undergoing LOUA.     

Medical management of uterine fibroids with medroxyprogesterone acetate (Depo Provera): a pilot study.

The aim of this study was to determine the effectiveness of medroxyprogesterone acetate (Depo Provera) in the treatment of menorrhagia attributed to uterine fibroids and to determine whether it reduces fibroid volume. Twenty premenopausal women with menorrhagia attributed to uterine fibroids received Depo Provera (150 mg/month) for 6 months. Control of bleeding was assessed by menstrual diary, haematologic parameters (Hb) and uterine and fibroid size measured sonargraphically. Following a period of 6 months after the initiation of Depo Provera, 30% became amenorrhoeic, 70% noticed improvement in their bleeding pattern and 15% had an increase in their haemoglobin levels. The mean uterine and fibroid volume was also reduced by 48% and 33%, respectively. Medical therapy with Depo Provera with symptomatic fibroids causes significant improvement in bleeding pattern as well as a reduction in fibroid volume.     

Permanent amenorrhea associated with endometrial atrophy after uterine artery embolization for symptomatic uterine fibroids

OBJECTIVE: To report a case of permanent amenorrhea associated with endometrial atrophy after uterine artery embolization for symptomatic uterine fibroids. DESIGN: Case report. SETTING: Gynecologic clinic of a university hospital. PATIENT(S): A 44-year-old woman with menorrhagia and anemia caused by multiple fibroids. INTERVENTION(S): Transcatheter bilateral uterine artery embolization with polyvinyl alcohol particles, with hormonal, sonographic, and hysteroscopic follow-up procedures. MAIN OUTCOME MEASURE(S): Serum follicle-stimulating hormone (FSH) and estradiol levels were measured, and sonographic appearance of the ovaries and the endometrium at baseline and 1, 3, 6, and 12 months after treatment were recorded. Hysteroscopy was performed with endometrial biopsy at baseline and 6 months after embolization. RESULT(S): The patient remained amenorrheic from the procedure. Serial posttreatment measurements of FSH and estradiol levels and repeated ovarian imaging showed no change in ovarian function as compared with baseline. A reduction in endometrial thickness (相似文献   

Uterine necrosis after laparoscopic uterine vessel dissection for symptomatic fibroid--a case report

Laparoscopic dissection of uterine vessels is a new minimally invasive method to treat symptomatic fibroids. A potential complication of uterine artery dissection is uterine necrosis. A woman with a large intramural fibroid underwent laparoscopic dissection of the uterine vessels using ultrasonic activated shears and three months later developed focal uterine necrosis requiring exploratory laparotomy and supracervical hysterectomy. Although uterine artery coagulation and dissection are procedures with a low reported rate of complications, uterine fibroid or focal uterine necrosis can occur.     

Laparoscopic radiofrequency thermal ablation: a new approach to symptomatic uterine myomas

OBJECTIVE: The purpose of this study was to evaluate the feasibility and efficacy of laparoscopic radiofrequency ablation of uterine fibroids. STUDY DESIGN: Eighteen women with symptomatic intramural uterine myomas underwent radiofrequency ablation under laparoscopic guidance. Postoperative sonographic evaluations of the fibroids size were scheduled at 1, 3, 6 ,9, and 12 months. The impact of myoma-related symptoms on quality of life (QOL) was assessed using a validated questionnaire. RESULTS: The median number of myomas treated per patient was 1 (1-3). The median baseline volume of the dominant myoma was 67.2 cm 3 (14.8-332.8). No intraoperative or postoperative complications occurred. The median reductions in myomas volume were 41.5%, 59%, and 77% at 1, 3, and 6-months, follow-up evaluation, respectively. No further change in fibroid size was observed at 9 months and 1 year. A significant improvement in the symptoms score and QOL score was observed at 3 and 6 months, follow-up. CONCLUSION: In this pilot study, laparoscopic radiofrequency ablation successfully reduced fibroid symptoms and fibroid volume in short-term follow-up. Additional studies are needed before its efficacy and safety can be confirmed.     

Magnetic resonance imaging-guided focused ultrasound surgery for symptomatic uterine fibroids: estimation of treatment efficacy using thermal dose calculations

Objective

To study the correlation between the predicted thermal dose volume (TDV) and the actual ablation volumes in MR-guided focused ultrasound surgery (MRgFUS) for symptomatic uterine fibroids, and to follow up the outcome for 12 months post-treatment.

Study design

Phase-difference fast spoiled gradient-echo MR images were used to analyze thermal change during the energy deliveries of MRgFUS in 60 consecutive patients treated for symptomatic uterine fibroids. The TDV obtained through analysis of these MR images was compared with the non-perfused volume (NPV) measured on post-treatment contrast enhanced T1-weighted images. Final values of TDV ratio and NPV ratio were obtained by dividing these values by original fibroid volume. Patients were followed for 12 months post-treatment to assess symptomatic relief using the symptom severity score (SSS).

Results

Treatments in which we managed to reach a TDV ratio larger than 27% of the treated fibroid yielded a ratio of NPV to TDV of 1.1 ± 0.5, indicating accurate control of the non-invasive procedure. Patient symptoms, as measured by the SSS, continuously decreased from a mean baseline score of 50 ± 22 to 19 ± 12 (P < 0.0001) 12 months post-treatment.

Conclusions

At large treatment volumes (exceeding 27% TDV ratio), thermal dose estimates correspond very closely to non-perfused volumes measured immediately post treatment. These large treatment volumes result in continuous clinical improvement throughout the first 12 months after MRgFUS.     

Fibroid volume, location and symptoms in women undergoing uterine artery embolization: does size or position matter?

OBJECTIVE: To investigate the relationship between MRI-determined uterine fibroid size and their location, and fibroid-related symptoms, including quality of life and sexual function, in women with symptomatic fibroids before uterine artery embolization (UAE). MATERIALS AND METHODS: Forty-six women underwent pelvic MRI within four weeks prior to UAE. The MRIs were analyzed and fibroid size and fibroid location were recorded. Women also completed a comprehensive self-report questionnaire within the four weeks prior to the procedure. The questionnaire (Short Form-36 (SF-36) and Female Sexual Function Index (FSFI), respectively, investigated the frequency of fibroid-related symptoms, as well as quality of life and sexual function. Pearson product moment correlation coefficients were used to examine relationships among variables, and ANOVAs were used to determine between-group difference. RESULTS: At baseline, women with symptomatic fibroids had worse quality of life and sexual function scores than healthy controls (p < .05). No fibroid-related symptoms, or aspects of quality of life or sexual function, were significantly correlated with either total uterine volume or largest fibroid volume. No significant differences with respect to fibroid-related symptoms were found between patients with or without subserosal or submucosal fibroids. CONCLUSIONS: Women with symptomatic fibroids pre-UAE had impaired quality of life and sexual function, but size and location of fibroids as determined by MRI were not related to fibroid-related symptoms, health-related quality of life, or sexual function.     

Vaginal expulsion of submucosal fibroids after uterine artery embolization. A report of three cases.

BACKGROUND: Since October 1996, at our fibroid center, we have been using the uterine artery embolization (UAE) procedure as a nonsurgical means to treat patients with fibroids and menorrhagia. We have performed this procedure on over 180 patients, 3 of whom experienced vaginal expulsion of submucosal fibroids from two to seven months later. CASES: A 37-year-old woman underwent UAE in November 1997 and expelled five submucosal fibroids two to three months later. A 43-year-old woman underwent UAE in August 1997 and expelled a submucosal fibroid four months later. A 46-year-old woman underwent UAE in April 1997 and expelled a submucosal fibroid seven months later. CONCLUSION: The use of UAE to treat patients with fibroids and menorrhagia is relatively new. Our experience has revealed that a significant percentage of patients who have had the embolization procedure will have reduction in menorrhagia and also in the volume of their fibroids. Complications and side effects have been few. Vaginal expulsion of submucosal fibroids can be viewed as a side effect of the procedure, and, to the best of our knowledge, these are the first reported cases of this postembolization occurrence.     

The role of uterine artery embolization in the management of uterine fibroids

PURPOSE OF REVIEW: Uterine artery embolization is increasingly being offered as an alternative to hysterectomy and myomectomy for the treatment of symptomatic uterine fibroids. This review is intended to evaluate the role of this technique in the management of uterine fibroids using information provided from recently published literature. RECENT FINDINGS: A growing body of literature supports the efficacy of uterine artery embolization in relieving fibroid-related menorrhagia, pelvic pain and pressure symptoms and in substantially reducing the fibroid size in most patients. Recent publications also show significant improvements in health-related quality of life and high long-term satisfaction rates. The procedure is associated with shorter hospitalization and recovery times and lower morbidity rates compared with conventional surgical treatments. However, serious complications, such as uterine infarction or infection leading to emergency hysterectomy, have been reported in a few cases, and considerable work is currently underway to determine how the safety of the procedure can be enhanced. Although no long-term data on subsequent fertility are yet available, early reports on ovarian function and pregnancy outcomes after uterine artery embolization are encouraging. SUMMARY: Based on current evidence, uterine artery embolization can be considered a valuable alternative to surgical therapy in the management of well-selected women with symptomatic uterine fibroids. Additional research is needed to help define the place of this technique for women who desire future pregnancy.     

The Ontario Uterine Fibroid Embolization Trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids

OBJECTIVE: To evaluate fibroid uterine volume reduction, symptom relief, and patient satisfaction with uterine artery embolization (UAE) for symptomatic fibroids. DESIGN: Multicenter, prospective, single-arm clinical treatment trial. SETTING: Eight Ontario university and community hospitals.Five hundred thirty-eight patients undergoing bilateral UAE. INTERVENTION(S): Bilateral UAE performed with polyvinyl alcohol particles sized 355-500 microm. MAIN OUTCOME MEASURE(S): Three-month follow-up evaluations including fibroid uterine volume reductions, patient reported symptom improvement (7-point scale), symptom life-impact (10-point scale) reduction, and treatment satisfaction (6-point scale). RESULT(S): Median uterine and dominant fibroid volume reductions were 35% and 42%, respectively. Significant improvements were reported for menorrhagia (83%), dysmenorrhea (77%), and urinary frequency/urgency (86%). Mean menstrual duration was significantly reduced after UAE (7.6 to 5.4 days). Improvements in menorrhagia were unrelated to pre-UAE uterine size or post-UAE uterine volume reduction. Amenorrhea occurring after the procedure was highly age dependent, ranging from 3% (1%-7%) in women under age 40 to 41% (26%-58%) in women age 50 or older. Median fibroid life-impact scores were significantly reduced after UAE (8.0 to 3.0). The majority (91%) expressed satisfaction with UAE treatment. CONCLUSION(S): UAE reduced fibroid uterine volume and provided significant relief of menorrhagia that was unrelated to initial fibroid uterine size or volume reduction. Patient satisfaction with short-term UAE treatment outcomes was high.     

MR imaging evaluation of fibroid clearance following open myomectomy for massive/multiple symptomatic fibroids

Purpose

To evaluate the technical success of total fibroid clearance at open myomectomy for massive and/or multiple symptomatic fibroids using MR imaging (MRI) as the imaging modality.

Methods

The study group comprised 27 women [mean age 37.4?±?6.9?years (range 27–53)] who underwent open myomectomy for the treatment of massive/multiple symptomatic fibroids at our institution between January 2009 and April 2010. Myomectomy was performed with the intention of achieving complete fibroid clearance. Pre- and postmyomectomy MRI was performed to assess changes in uterine volume and fibroid burden. Periprocedural data (including blood loss and complications) and relief of clinical symptoms at follow-up were also recorded.

Results

The mean time to MRI and clinical follow-up was 10?months (range 6–15?months). The mean uterine volume premyomectomy was 795?±?580?cc and postmyomectomy was 123?±?70?cc (p?<?0.001). The mean percentage reduction in uterine volume was 80.3?% (range 43.0–98.1?%). Of the 10/27 (37.0?%) women with residual fibroids at follow-up: 7 patients had fibroids measuring up to 1?cc in volume, 3 patients had fibroids measuring up to 6?cc. Postoperative adnexal seromas were observed in 6/27 (22.2?%) patients. The clinical success rates of myomectomy amongst the 22/27 (81?%) responders were: 73?% for menorrhagia, 64?% for pain, and 36–64?% for mass-related symptoms.

Conclusions

Using MRI, we have confirmed that open myomectomy can achieve total or near-total fibroid clearance in the majority of patients with massive and/or multiple fibroids.