DSA下经导管甲氨蝶呤局部灌注子宫动脉栓塞治疗子宫腺肌病的临床疗效

目的：探讨血管数字减影术（DSA）引导经导管甲氨蝶呤局部灌注子宫动脉栓塞治疗子宫腺肌病的临床疗效及安全性。方法：选取诊断为子宫腺肌病患者100例,在DSA引导下以Selainger技术于双侧子宫动脉形成导管导丝插管,DSA证实插管位置正常后注入甲氨蝶呤50mg,以聚乙烯醇微球颗粒进行栓塞,患者术后3个月、6个月月经干净后3-7d时复查,观察月经周期、月经量、痛经情况、子宫体积大小及子宫动脉血流阻力指数（RI）及性激素卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）、睾酮（T）、孕酮（P）、泌乳素（PHL）变化,术中及术后并发症发生情况。结果：手术后3个月、6个月患者所用卫生巾片数、月经周期、痛经评分明显减少,子宫体积缩小,RI值明显下降,治疗后明显较治疗前改善,比较差异具有统计学意义（P〈0.05）;在治疗后性激素FSH、LH、E2、T、P、PHL无明显变化,无治疗前比较差异无统计学意义（P〉0.05）;术后腹痛发生率100.00%,少见发热、恶性呕吐症状,对症处理后症状缓解。结论：在DSA引导下以甲氨蝶呤结合子宫动脉栓塞治疗子宫腺肌病,能明显改善患者临床症状,手术安全,近期疗效较好。

The Efficacy of Uterine Artery Embolization in the Treatment of Adenomyosis by DSA Guided Local Methotrexate Perfusion

Objective： To investigate the clinical efficacy and safety of uterine artery embolization in the treatment of adenomyosis by perioperative vascular digital subtraction angiography（ DSA） guided local methotrexate perfusion. Method： 100 patients with adenomyosis were collected. After DSA guided intubation,50mg methotrexate was injected. The patients were reviewed after treatment for 3months,6 months and menstrual clean for 3-7 days. The menstrual cycle,menstrual quantity,period pain,uterine size and uterine artery blood flow resistance index（ RI） and sex hormone,follicle-stimulating hormone（ FSH）,luteinizing hormone（ LH）,estradiol（ E2）,testosterone（ T）,progesterone（ P）,prolactin（ PHL） change,intraoperative and postoperative complications were observed. Result： After treatment for 3 months and 6 months,the sanitary napkin counting scores,menstrual cycle,menstrual cramps,uterine volume shrinking,RI value was significantly decreased. There was significantly changes after treatment than before treatment（ P ＆lt; 0.05）. After treatment FSH,LH,E2,T,P,PHL was no obvious changes（ P ＆gt; 0.05）. The incidence of postoperative abdominal pain was 100%. The fever and malignant vomiting was rare. Conclusion： Uterine artery embolization in the treatment of adenomyosis by DSA guided local methotrexate perfusion can significantly improve the clinical symptoms.