摘要
目的探讨经导管子宫动脉栓塞(TUAE)治疗子宫肌瘤的中期效果及其影响疗效的因素。方法78例子宫肌瘤患者接受TUAE治疗,其中71例伴有经血过多、下腹部或腰腿胀痛、尿频、尿急等不同症状。78例中,壁间肌瘤72例,黏膜下肌瘤6例;多发肌瘤71例,单发肌瘤7例。肌瘤最大直径≤3cm者30例,>3cm者48例。栓塞剂采用碘油平阳霉素乳剂(LPE),其中碘油用量为8～20ml,平阳霉素用量为8～16mg,46例加用明胶海绵颗粒(GSP)栓塞子宫动脉近端。78例中71例行双侧子宫动脉栓塞,7例行单侧栓塞(5例本身为单一子宫动脉供血,2例插管失败)。所有病例栓塞后随访超过3年。结果总的症状改善有效率为97.4%,肌瘤体积1、2、3年平均缩小率分别为59.8%、62.7%和64.6%,子宫体积1、2、3年平均缩小率分别为50.1%、53.9%和55.8%,未见复发病例。肌瘤最大直径≤3cm者,栓塞后肌瘤体积较最大直径>3cm者缩小更明显;黏膜下肌瘤疗效优于壁间肌瘤。加用GSP栓塞,肌瘤缩小更明显;但加大碘油和平阳霉素用量不能增加肌瘤缩小率。双侧栓塞疗效明显优于单侧栓塞。结论TUAE治疗子宫肌瘤具有较好的中期效果,影响其疗效的因素主要包括肌瘤大小和部位、是否加用GSP栓塞以及是否行双侧子宫动脉栓塞。
Objective To evaluate the midterm result of transcathether uterine artery embolization （TUAE） in the treatment of uterine fibroids and its factors affecting outcome. Methods TUAE was performed in 78 cases of uterine fibroids. Mean patient age was 39.8 years （range, 29-48 years） . Of them, 71 patients presented with menstrual bleeding, lower abdominal and/or lumbago pain, and utinary irritation. There were intramural myomas in 72 patients and submucous in 6 patients. There were multiple myomas in 71 patients and single in 7 patients. The largerest dominant myomas diameter was≤3 cm in 30 patients and 〉3 cm in 48 patients. Lipiodol-pingyangmycin emulsion （LPE） was used as embolic agent with amount of lipiodol ranged from 8-20 ml and pingyangmycin from 8-16 mg. Forty-six patients followed by embolization with Gelfoam sponge particles （GSP）. Bilateral uterine arteries were embolized in 71 patients and unilateral in 7 patients （becausing of an absent uterine artery in 5 patients and technical failure in 2 patients）. The follow-up period of all patients was over 3 years. Results Total improvement of symptoms occurred in 97.4%. The median reduction in the fibroid volum was 59.8% at 1 year, 62.7% at 2 years and 64.6% at 3 years, respectively. The mean uterine volume reduction rates was 50.1% at 1 year, 53.9% at 2 years, and 55.8% at 3 years, respectively. There was a much higher percentage reduction in the fibroid volume in the patients with the largerest dominant diameter ≤3 cm than in the patients with the largerest dominant diameter〉3 era. A submucosal leiomyoma location was associated with a greater volume reduction. Embolization with combination of PLE and GSP had improved a percentage reduction in myomas volume, but increasing of dose of lipiodol and pingyangmycine did not improve a percentage reduction in rnyoma volume. Conclusion TUAE is associated with a good mid-term efficacy in treatment of uterine fibroids. The factors affecting results include tumor size and location, using of GSP,
出处
《中国介入影像与治疗学》
CSCD
2005年第6期409-413,共5页
Chinese Journal of Interventional Imaging and Therapy
基金
广东省卫生厅高难
高新技术项目(C2000031)
广东省医学科研课题(A2001065)基金资助。
关键词
子宫肌瘤
栓塞
治疗性
随访研究
Uterine neoplasms
Embolization, therapeutic
Follow-up studies
