子宫腺肌病子宫动脉栓塞术治疗前后血流动力学的变化

目的　了解子宫动脉栓塞术 (UAE)治疗子宫腺肌病前后血流动力学的变化。方法　对3 0例用明胶海绵为栓塞剂行UAE治疗的子宫腺肌病患者 ,于UAE前 1周内和UAE后 7、3 0、90d行经腹部彩色多普勒超声检查 ,测量双侧子宫动脉平均流速 (Vm)、阻力指数 (RI)、搏动指数 (PI) ,并用能量图 (CDE)观察正常子宫肌层和病灶内的血流情况。结果　 ( 1)与UAE前相比 ,UAE后Vm、RI、PI均明显减少 (P <0 0 1) ,以UAE后 7d下降最为明显 ,其中Vm下降了 63 % [UAE前为 ( 41± 11)cm/s,UAE后 7d为 ( 15± 9)cm/s],差异有极显著性 (P <0 0 1) ;UAE后 3 0、90d虽逐步上升 ,其中Vm较UAE前仍分别下降 41% [( 2 4± 9)cm/s]和 41% [( 2 4± 10 )cm/s],与UAE后 7d比较 ,差异有显著性 (P<0 0 5 )。( 2 )UAE后 7d ,正常子宫肌层血流稀少 ,病灶内血流稀少或无血流 ;UAE后 3 0、90d ,正常子宫肌层的血流逐渐增多 ,病灶内血流仍稀少或无血流。结论　用明胶海绵行UAE治疗子宫腺肌病后7～ 3 0d ,子宫肌层的血液供应逐渐恢复 ,病灶的血液供应绝大部分不能恢复

Investigation of the hemodynamic changes during uterine arterial embolization in the treatment of adenomyosis

Objective To investigate the hemodynamic changes before and after uterine arterial embolization(UAE) in the treatment of adenomyosis. Methods UAE was performed in 30 patients with adenomyosis diagnosed by clinical manifestation, magnetic resonance and/or color Doppler flow imaging (CDFI). The mean flow velocity(Vm), resistance index(RI) and pulsatility index(PI) of bilateral uterine arteries were measured by CDFI 1 week before,1 week,1 month and 3 months after UAE. Mean time of the blood flow in normal myometrium and adenomyosis lesions were observed by color Doppler energy. Results Vm, PI and RI were markedly reduced after UAE, especially on the 7th day after UAE (P<0.01). Concomitantly the blood flow volume (BFV) in normal myometrium was also decreased and recovered to normal again 1 month and 3 months after treatment (P<0.05, compared to the 7th day after UAE) but the BFV inside the adenomyosis lesion kept lower state after UAE. Conclusions The most obvious hemodynamic changes of uterine arteries occurred 1 week after UAE .The blood supply of normal myometrium recovered to normal after 30 days. But those of lesions were irreversible until 3 months after UAE.