DSA引导下多水平栓塞在子宫肌瘤栓塞治疗中的作用

目的：评价应用直径300-500μm的聚乙烯醇（polyvinyl alcohol,PVA）颗粒单纯子宫动脉栓塞与采用直径300-500μm及500-700μm PVA颗粒的多水平子宫动脉栓塞对子宫肌瘤患者的疗效和安全性。方法：将50例症状型子宫肌瘤患者随机分为A、B 2组,A组应用300-500μm直径的PVA颗粒栓塞至子宫动脉血流停滞、螺旋状动脉不显影;B组应用300-500μm直径的PVA颗粒栓塞至子宫动脉血流变慢后再应用500-700μm直径的PVA颗粒栓塞子宫动脉,直到子宫动脉主干血流停滞、螺旋状动脉不显影,并比较2组症状缓解、疗效和并发症情况。结果：（1）临床症状变化情况比较：A、B 2组的临床症状（经期时间、月经量、贫血、痛经、下腹坠胀、尿频和排尿困难）比较,差异无统计学意义（P〉0.05）;（2）疗效比较：栓塞治疗后6个月复查,结果显示A组肌瘤平均体积由87.45 cm3缩小为48.65 cm3,B组肌瘤平均体积由91.87 cm3缩小为38.25 cm3,组内术前与术后比较均有显著差异（P〈0.001）,组间术后比较有显著差异（P〈0.05）;（3）并发症比较：2组并发症发生率没有显著差异（P〉0.05）。结论：与单纯应用直径300-500μm的PVA颗粒相比较,应用直径300-500μm及500-700μm PVA颗粒的多水平子宫动脉栓塞,可显著提高子宫肌瘤坏死缩小程度,而并发症的发生率无显著差异性,提示子宫肌瘤的多水平栓塞治疗技术是有效、安全的。

DSA-guided uterine artery embolization at multiple levels for therapy of uterine leiomyoma

Objective To compare the effects and safety of uterine artery embolization with particles of polyvinyl alcohol（PVA） for the therapy of uterine leiomyoma, involving in PVA particles with diameters of 300-500 μm or 300-500 μm mixed with 500-700 μm. Methods Totally 50 uterine leiomyoma patients were divided into group A and group B randomly. In group A, 300-500 μm PVA particles were used for embolization to stop uterine artery blood flow and development of spiral blood vessels. In group B, 300-500 μm PVA particles were used to slower uterine artery blood flow, and then 500-700 μm PVA particles were used to stop uterine artery blood flow and development of spiral blood vessels. The two groups were compared for the symptom changes, effects and complications. Results There was no significant differences between the symptoms in the two groups, including menstrual duration, menstrual amount, anemia, dysmenorrheal,lower abdominal bulge, pollakiuria and dysuria, with P0.05. Reexamination 6 months after therapy proved that the mean size of the leiomyoma in group A decreased from 87.45 cm3 to 48.65 cm3 and the one in group B from 91.87 cm3to38.25 cm3. There were statistical differences between the mean sizes before and after therapy with P0.001, and between the mean sizes in the two groups with P 0.05. There was no significant difference between the complications of the two groups, with P 0.05. Conclusion Compared with the embolization with 300-500 μm PVA particles, the one with 300-500 μm mixed with 500-700 μm particles can significantly relieve uterine leiomyoma, with no more complications. Uterine artery embolization at mulitiple levels is proved effective and safe for the therapy of uterine leiomyoma.