子宫肌瘤的介入治疗

目的　评价子宫动脉栓塞术治疗子宫肌瘤的疗效。方法　对 182例子宫肌瘤患者进行超选择性子宫动脉栓塞术。结果　栓塞双侧子宫动脉 173例 ,单侧 9例。 168例完整随访者术后 6个月子宫体积平均缩小 42 % ,16例肌瘤消失 ,15 2例肌瘤体积平均缩小 67%。临床症状明显改善。主要副作用为下腹部疼痛 ( 13 5 /182 )。结论　子宫动脉栓塞术是治疗子宫肌瘤的良好方法。     

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。     

碘油平阳霉素乳剂联合利多卡因浸泡明胶海绵栓塞治疗子宫肌瘤的临床观察

目的探讨平阳霉素、利多卡因、碘化油乳剂及经利多卡因浸泡的明胶海绵颗粒栓塞子宫动脉治疗子宫肌瘤的可行性和疗效。方法对68例子宫肌瘤患者应用平阳霉素、利多卡因、碘油乳剂及经利多卡因浸泡的明胶海绵颗粒栓塞治疗,观察术中、术后的疼痛反应、临床症状和肌瘤大小的变化、子宫体积变化及标本病理学表现。结果术中、术后患者疼痛反应较轻,需肌注镇痛剂控制难以忍受疼痛者13例,占19.1%;症状缓解率为92.3%,其中89.5%月经异常得以恢复,盆腔疼痛与腹胀及压迫症状消失达90.8%。3～6个月随防肌瘤平均缩小78.9%,子宫体积平均缩小47.5%。结论平阳霉素、利多卡因、碘油乳剂及经利多卡因浸泡的明胶海绵颗粒是治疗子宫肌瘤较为理想的栓塞材料。     

综合应用碘油、PVA、明胶海绵颗粒介入治疗子宫肌瘤的临床研究

目的探讨应用碘油、PVA、明胶海绵颗粒介入治疗子宫肌瘤的临床效果.方法对36例子宫肌瘤进行选择性双侧子宫动脉栓塞灌注碘油、PVA、明胶海绵,随访3～20个月,平均9个月,观察术后症状缓解情况,子宫缩小和肌瘤缩小程度.结果36例右侧股动脉穿刺操作全部成功.子宫肌瘤动脉造影,表现为子宫动脉明显增粗、迂曲、分支增多、子宫增大、肿瘤染色灶明显.栓塞后肌瘤染色灶明显消失,栓塞剂加用抗生素,术后反应(发热、疼痛、呕吐)明显减轻,子宫肌瘤缩小率46.3%～91.7%,其中肌瘤缩小50%以上占86.6%,性激素术前、术后无明显差异.结论综合应用碘油、PVA、明胶海绵颗粒介入治疗子宫肌瘤是非手术治疗的良好方法.     

超声在子宫肌瘤的子宫动脉栓塞术疗效评价中的价值

目的:探讨超声在子宫动脉栓塞术治疗子宫肌瘤术后疗效随访中的应用价值。材料和方法:58例子宫肌瘤患者分别在栓塞术前1周、术后1个月、6个月、12个月运用超声观察子宫大小形态、肌瘤大小形态和血流动力学的改变。结果:术后1个月子宫体积平均缩小44.24%,肌瘤体积平均缩小43.74%;术后6个月子宫体积平均缩小62.72%,肌瘤体积平均缩小61.25%;术后1年子宫体积平均缩小72.17%,肌瘤体积平均缩小70.18%。其中以单发肌瘤、内膜肌瘤患者疗效明显,肌瘤的血供较术前明显减少。结论:超声在评价子宫动脉栓塞术治疗子宫肌瘤术后疗效中有重要价值。     

经导管动脉栓塞术在子宫肌瘤中的应用

目的　探讨经导管超选择性子宫动脉栓塞术治疗子宫肌瘤的临床应用价值。方法　 10 3例子宫肌瘤 ,采用双侧子宫动脉插管造影和栓塞治疗 ,栓塞剂为聚乙烯醇 (PVA)和明胶海绵。 67例栓塞后随访资料完整 ,并对造影所见、治疗后反应、症状变化和肌瘤大小改变进行总结和分析。结果　造影表现为子宫动脉增粗、扭曲及肿瘤染色。治疗后数月内月经增多症状均有不同程度改善 ,肌瘤均有缩小 ,肌瘤缩小程度随时间延长而显著。结论　经导管子宫动脉栓塞术对控制症状、缩小肌瘤体积有显著作用 ,是一种安全、有效的治疗子宫肌瘤的方法     

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     

白芨加明胶海绵栓塞治疗子宫肌瘤的疗效观察

目的：评价白芨加明胶海绵栓塞治疗子宫肌瘤临床疗效。方法：收集我院2000年5月至2003年5月用白芨加明胶海绵栓塞治疗子宫肌瘤病人50例，采用Seldinger技术，对50例子宫肌瘤患者进行选择性子宫动脉栓塞治疗。栓塞后3个月，6个月、12个月、24个月、36个月、48个月行临床与B超随访观察疗效。结果：超选择性插管及栓塞成功率为100％，栓塞后绝大多数患者临床症状消失，随访16—48个月，1例因子宫感染坏死行子宫切除，1例40个月后肌瘤又增大行子宫切除，2例闭经，15例肌瘤消失，31例肌瘤不同程度的缩小。结论：白芨加明胶海绵栓塞治疗子宫肌瘤是一种创伤小、术后并发症发生率低，可以保留子宫及其功能的治疗措施，可使子宫肌瘤患者临床症状减轻或消失、肌瘤实体进行性缩小或消失。     

白芨加明胶海绵栓塞治疗子宫肌瘤的临床应用

目的：探讨白芨加明胶海绵栓塞治疗子宫肌瘤的临床应用,了解此方法的疗效;不良反应及并发症。方法：采用Seldinger技术,对21例子宫肌瘤患者进行选择性子宫动脉栓塞。通过动脉导管注入白芨微粒和明胶海绵颗粒,阻断肌瘤供血。结果：血管造影发现子宫肌瘤主要由双侧子宫动脉供血,血供丰富,双侧子宫动脉栓塞后,肌瘤部位血管征象消失,治疗后3－6个月随访结果表明：肌经治疗前缩小38％－90％,临床症状改善,1例因感染而行子宫切除。结论：白芨加明胶海绵栓塞治疗子宫肌瘤近期临床效果好,远期疗效尚有待观察。     

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。     

超选择子宫动脉栓塞治疗子宫肌瘤

目的：研究超选择子宫动脉栓塞治疗子宫肌瘤的临床疗效。方法：于2000年2月－8月对28例子宫肌瘤患者进行双侧子宫肌瘤供血动脉的栓塞治疗。结果：插管栓塞成功率100％,随访1－6个月。B超示术后随访1个月肌瘤体积平均缩小25％。随访6个月,8例肌瘤消失,20例肌瘤体积平均缩小68％,并均伴有月经量的明显减少。结论：子宫肌瘤的介入治疗疗效肯定,对黏膜下子宫肌瘤尤为适宜。     

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.     

子宫肌瘤栓塞术的护理

目的：探讨子宫肌瘤栓塞术的术前、术中、术后的护理措施。方法：分析总结68例施行该手术的患者在术前、术中及术后各期进行相应的护理经验和体会。结果：所有患者术后症状改善或消失，无并发症，效果满意。结论：子宫肌瘤栓塞术痛苦小、相对安全、是治疗子宫肌瘤的有价值的方法之一，细致、周到的护理工作也是手术成功的重要保证。     

子宫肌瘤DSA动脉造影152例分析

目的分析152例子宫肌瘤DSA血管造影的表现,总结子宫肌瘤血供特点和子宫动脉与主干的分叉角度,指导介入栓塞操作。方法子宫肌瘤行子宫动脉栓塞治疗的病例152例。术前均经B超、CT或MRI证实。肿瘤位于肌壁间74例,黏膜下32例,黏膜下和肌壁间共存46例。股动脉穿刺成功后行腹主动脉下端造影,其中91例进行旋转DSA快速造影。分别测量子宫动脉起始部分叉类型及其与主干的分叉角度,比较两侧子宫动脉供血的优势类型和各时相的表现特点。结果插管和DSA造影技术成功率100%。子宫动脉分叉成角小于30°者81例(53.3%),30°～60°者52例(34.2%),大于60°者19例(12.5%)。子宫动脉血管粗细和分支多少两侧不等者112例(73.7%),大量供血动脉包绕肌瘤者98例。实质期子宫肌瘤染色者124例(81.6%)。91例旋转DSA造影清楚显示子宫动脉开口达到89例(97.8%)。结论子宫肌瘤患者的子宫动脉大多明显增粗,两侧不对称常见。子宫肌瘤大多为富血供肿瘤,但是造影剂染色时间较晚。部分子宫动脉起始部与主干分叉角度较大,需在子宫动脉介入治疗时注意。     

子宫肌瘤导管栓塞治疗后的病理改变

探讨子宫肌瘤行经导管子宫动脉栓塞(TUAE)治疗后的病理变化及临床意义。研究证实,TUAE后肌瘤组织随时间改变呈现动态病理变化,即先发生充血、水肿,随后发生坏死,最后出现纤维组织增生,这一动态病理变化是TUAE后肌瘤体积不断缩小的病理基础。绝大多数肌瘤呈不完全坏死,因此肌瘤可能复发。影响坏死范围的因素包括肌瘤大小与部位及栓塞后时间长短。TUAE后正常子宫组织可能出现炎症反应,但无坏死改变。周围附件器官末梢血管发现栓塞剂,提示TUAE对卵巢、输卵管功能有潜在的影响。     

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.     

Cost-effectiveness of uterine artery embolization and hysterectomy for uterine fibroids

PURPOSE: To compare the cost-effectiveness of uterine artery embolization (UAE) with that of hysterectomy for women with symptomatic uterine fibroids. MATERIALS AND METHODS: The authors developed a decision model to compare the costs and effectiveness of UAE and hysterectomy. In the model, a cohort of women aged 40 years with a diagnosis of uterine fibroids and no desire for future pregnancy was followed up until menopause. The analysis was performed from a societal perspective, including all costs and effects, regardless of who incurs them. Transition probability and quality-of-life estimates were obtained from the literature and a gynecologist, whereas costs (in 1999 U.S. dollars) were estimated by using rates of Medicare reimbursement for hospital costs and physician fees. Sensitivity analyses of key estimates were performed. Results were expressed in costs per quality-adjusted life-year (QALY). RESULTS: UAE was more effective (8.29 vs 8.18 QALYs) and less expensive (US dollars 6916 vs US dollars 7847) than hysterectomy. Cost-effectiveness results, with the exception of quality-of-life data, were robust to changes in most model assumptions. When the quality-of-life adjustment was eliminated, the two procedures were equally effective. CONCLUSION: UAE is a cost-effective alternative to hysterectomy across a wide range of assumptions about the costs and effectiveness of the two procedures. However, the study results were sensitive to changes in quality-of-life values.