经阴道彩色能量多谱勒超声在子宫肌瘤栓塞中的作用

The Value of Transvaginal Color Doppler Energy Sonography in Uterine Fibroids Embolization

目的探讨经阴道彩色能量多谱勒超声在子宫肌瘤栓塞治疗中的作用。资料与方法通过对27例子宫肌瘤患者进行子宫动脉栓塞治疗,并应用经阴道彩色能量多谱勒超声在栓塞前、栓塞后当天、第5d、栓塞半年内每次月经干净后第3～4d内及栓塞后每年进行检查,追踪随访34～58个月。结果栓塞前月经量过多19例,术后3个月内月经量恢复正常18例。监测发现,栓塞前肌瘤部分血流信号丰富22例,一般2例,稀少但肌瘤周边有环状血流信号2例和无血流信号1例;子宫肌层血流信号均丰富。26例栓塞后超声发现肌瘤一直无血流信号,子宫肌层血流信号在术后第5d后的每次复查均丰富。栓塞术后症状无改善1例,术后第5d和1个月发现肌瘤血流信号较丰富与术前相近。栓塞前均可探测典型的子宫动脉频谱,栓塞后子宫动脉频谱消失,在栓塞后半年到2年内子宫动脉复通。随访期内出现临床症状的再发肌瘤2例,没有临床症状但超声检查发现再发肌瘤2例。子宫体积缩小率(50.89±1.63)%(t值3.921,P<0.001),子宫肌瘤体积缩小率(56.76±7.94)%(t值4.643,P<0.001),半年后肌瘤和子宫的体积维持稳定,没有变化。结论术前对子宫肌瘤进行血流信号的检测有利于术前对肌瘤栓塞疗效的判断;术后对子宫和肌瘤的短期(栓塞后1周内)动态监测有助于对肌瘤栓塞疗效的分析;术后定期对肌瘤行超声检查有利于子宫肌瘤再发的监测。

Objective To evaluate the value of transvaginal color Doppler Energy sonography （TVCDE） in uterine fibroids embolization. Materials and Methods The uterine artery embolization （UAE） was performed in 27 patients with uterine fibroids. All the patients were examined with TVCDE before and after UAE on the 1st day, 5th day, the day after the menses was over in consecutive 6 months and the day when the menses was over, all of patients were following up 34 ～ 58 months. Results There was menorrhagia in 19 patients, menorrhea became normal in 18 cases within 3 months. There were rich blood flow signals in fibroids in 22 cases, general blood flow signals in fibroids in 2 cases before UAE. Blood flow signals were rare in fibroids but visualized round the fibroids in 2 cases before UAE. There was no blood flow signal in fibroids in 1 case before UAE. There were rich blood flow signals in myometrium before UFE. The CDE showed that there were rare or no blood flow signal in the fibroids after UAE in 26 cases. The blood flows signal had been recovery and rich in myometrium since the 5th day after UAE. There was no symptom improved in 1 case whose blood flow signals in fibroids were rich and similar to that before UAE on the 5th day and 1 month later after UAE. In follow up period, there were symptomatic recurrent fibroids in 2 cases and nonsymptomatic recurrent fibroids detected with TVCDE in 2 cases. The frequency spectrum of uterine artery was detected before embolization and had been not observed from the day of UAE to haft year later after UAE. Uterine artery had been detected from half year to 2 yearn later after embolizstion. The rates of shrinkage of uterine volume and fibroids volume were （50.89 ± 1.63）% （t value 3,921, P 〈 0.001 ） and （56.76 ± 7.94） % （t value 4.643, P 〈 0,001） respectively. The volumes of uterus and fibroids had been stable since half year after embolization. Conclusion The detection of blood flow signal in fibroids with TVCDE before UAE is helpful in evaluating the effect of uterine flbroids embolization （UFE）, the dynamic and short time inspections of fibroids and myometrium are helpful in analyzing the effect of UFE and judging the prognosis, the regular detection of flbroids is helpful in finding the recurrence fibroids.