甲氨喋呤瘤体内注射治疗子宫肌瘤的临床观察

目的探讨超声引导下经阴道瘤体内注射氨喋噙（MTX）治疗子宫肌瘤的疗效。方法对165例子宫肌瘤患者行超声引导下经阴道瘤体内注射MTX治疗，剂量50-60mg，每月1次，连续注射3个月，超声下观察肌瘤体积变化。其中9例患者在注药1个月后接受手术治疗，切除的肌瘤标本送病理检查。结果注药1个月后体积与治疗前相比无明显变化（P〉0．05）；3次注药6个月后肌瘤体积与治疗前相比明显缩小（P〈0．01），注药1年后肌瘤体积与注药2年后的体积相比较差异无显著性意义（P〉0．05）。注药后的肌瘤标本光镜下可见其单位视野内的血管数明显减少，并有管腔变窄，肌瘤细胞有明显的水肿及变性；电镜下可见瘤细胞内内质网及线粒体有明显的水肿及变性，而正常子宫肌组织未见异常。结论超声引导下经阴道瘤体内注射MTX治疗子宫肌瘤，疗效明显，操作简单，副作用小。

Clinical observation of ultrasound-guided injection of MTX into uterine leiomyoma

Objective To investigate the efficiency of the treatment of uterine leiomyoma by ultrasoundguided injection of methotrexate(MTX)into leiomyoma transvaginally.Methods One hundred and sixtyfie cases of uterine myomas were treated with the ultrasound-guided injection of MTX into leiomyoma transvaginally,50～60 mg of MTX was injected into leiomyoma once a month for 3 consecutive months.The changes of myoma size before and after the injection were observed with ultrasound.Nine of 165 cases underwent hysterectomy or myomectomy 1 month after the injection.The specimens were studied pathologically.Results The mean tumor size of 156 patients was not significantly different between one month after the first injection/and before the injection(P>0.05).Six months after the third injections, the tumor sizes were significantly decreased,compared with those before the treatment(P<0.01).Two years later the tumor size was not significantly different from that after one year(P>0.05).Under the light microscope,blood vessels in five removed tumor specimens showed sparse distribution,indicating that blood vessels decreased in number and became narrower.Apparent degeneration and edema were found in leiomyoma tissues.Under the electronic microscope,degeneration and edema were observed in mitochondria and endoplasmic retichlum.Degeneration or necrosis were not seen in myometrium.Conclusion The ultrasound-guided injection of MTX into leiomyoma transvaginally has satisfactory definite prostecdtive efficacy.It is easily operated and has little side effect.