经导管子宫动脉栓塞治疗子宫肌瘤并发闭经的原因分析

Analysis of amenorrhea after transcatheter uterine artery embolization for uterine fibroids

目的探讨经导管子宫动脉栓塞(TUAE)治疗子宫肌瘤并发闭经的原因。方法搜集1999年4月至2004年5月,接受TUAE治疗的子宫肌瘤患者231例,年龄29～51岁,平均39.5岁。TUAE均采用经导管双侧子宫动脉注射碘油平阳霉素乳剂的方式,其中碘油用量6～20ml,平阳霉素用量8～16mg,231例中186例加用明胶海绵颗粒栓塞。结果231例中2例分别于TUAE后3和4个月发生闭经,发生率0.87%。1例考虑为卵巢功能受损引起的闭经,表现为雌二醇(E2)下降,促卵泡成熟激素(FSH)增高,经过1年的雌孕激素序贯治疗,患者月经逐渐恢复正常;另1例经宫腔镜证实为子宫内膜萎缩所致。结论TUAE后极少数人可发生闭经,其原因与卵巢功能受损及子宫内膜萎缩有关。

Objective To investigate the causes of amenorrhea after transcatheter uterine artery embolization（TUAE） for uterine fibroids. Methods Two hundreds thirty-one cases of uterine fibroids with the range of age from 29 to 51 years （ mean, 39.5 years） underwent TUAE between April 1999 and May 2004. TUAE was performed by injecting lipiodol-pingyangmycine emulsion （LPE） into bilateral uterine arteries, followed by administration of gelatin sponge particles in 186 of 231 patients. LPE was prepared with pingyangmycine 8 - 16 mg and ultra fluid lipiodol 6 - 20 ml. Results Amenorrhea occurred in 2 of 231 （0. 87% ） patients respectively at 3 and 4 months after TUAE. Premature ovarian failure was proved to be etiology of amenorrhea in one patient because her serum estradiol （ E2 ） became decreased and serum folliclestimulating hormone （FSH） level increased. This woman had normal amenorrhea later after receiving estrogen-progestogen sepuential therapy for 12 months. Another patient＇s amenorrhea was proved to be associated with endometrial atrophy after TUAE by hysteroscope. Conclusion Amenorrhea caused by premature ovarian failure and endometrial atrophy may occur in a tiny minority of women undergoing TUAE.