子宫肌瘤导管栓塞治疗的远期效果观察

目的探讨经导管子宫动脉栓塞（TUAE）治疗子宫肌瘤的远期效果及安全性。资料与方法对231例子宫肌瘤患者行TUAE治疗。患者肌瘤体积19—504cm^3（平均121cm^3），其中壁间肌瘤191例，黏膜下肌瘤36例，浆膜下肌瘤4例；单发16例，多发215例。所有病例均行双侧子宫动脉栓塞，栓塞剂为碘油．平阳霉素乳剂，其中186例加用了明胶海绵颗粒栓塞。随访期间，观察患者症状改善情况、肌瘤与子宫体积变化、有无复发、有无闭经及其他并发症情况。结果随访6—48个月，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，TUAE后1、2、3、4年肌瘤平均体积缩小率分别为60．7％、63．3％、65．6％、67．4％，子宫平均体积缩小率分别为49．6％、54．3％、55．2％、57．1％，无肌瘤复发现象。并发症包括臀部瘀血溃烂（1例）、小阴唇溃疡（1例）、尿潴留（12例）、尿路感染（1例）、阴道排泄坏死肌瘤组织（24例）、卵巢囊肿继发感染（1例）、子宫内膜增厚与钙化（1例）以及闭经（2例）等。结论TUAE治疗子宫肌瘤的远期效果确切，个别患者可以引起某些严重的并发症和／或后遗症，因此应严格选择病例。

The Long-term Results of Transcatheter Uterine Artery Embolization for Uterine Myoma

Objective To evaluate the long-term results and safety of transcatheter uterine artery embolization (TUAE) for u-terine myoma. Materials and Methods 231 cases of uterine myoma were treated by TUAE. The volumes of uterine myoma detected by ultrasound ranged from 19 cm3 to 504 cm3(mean, 121 cm3). There were intramural myoma in 191 cases, submucous myoma in 36 cases and subserous myoma in 4 cases, solitary in 16 cases and multiple in 215 cases. The TUAE through bilateral uterine arteries were performed using lipiodol-pingyingmycine emulsion (LPE) and gelatin sponge particles in 186 cases and using LPE aline in 45 cases. Clinical evaluation was made at regular intervals after embolization to assess patient outcome including the improvement of symptoms, reduction of the myoma volume and uterine volume, and the morbidity of recurrence, menoschsis and complications. Results The follow-up period ranged from 6 to 48 months. Menorrhagia became normal or improved markedly in 96.0% (193/201). Lumbago and lower abdominal pain disappeared or improved markedly in 94.9% (94/99). Bulk-related symptoms disappeared or improved markedly in 96.0% (48/50) . Ultrasound revealed that the mean largest tumor volume reduction rates were 60.7% at 1 year, 63.3% at 2 year, 65 .6% at 3 year and 67.4% at 4 year after embolization, and the mean u-terine volume reduction rates were 49.6% at 1 year, 54.3% at 2 year, 55.2% at 3 year and 57.1 % at 4 year after embolization. No new myoma occurred. Complications included ecchymosis and ulceration on buttock ( n = 1) ; ulcer of latia minora (n = 1); urinary retention ( n = 12) ; urinary tract infection ( n = 1); expelling of necrotic fibroids per vagina ( n = 24) ; secondary infection of chocolate cyst of ovary ( n = 1); increasing in endometrial thickness and calcification ( n = 1) and amenorrhea ( n = 2). Conclusion TUAE is associated with a good long-term efficiency. Some serious complications or sequelae can be caused in few patients.