子宫动脉栓塞治疗粘膜下子宫肌瘤的研究

The effect of uterine artery embolization on treatment of submucous uterine myoma

目的探讨子宫动脉栓塞（uterine artery embolization，UAE）治疗粘膜下子宫肌瘤的疗效和转归。方法对我院2000年6月～2004年6月的41例单发粘膜下子宫肌瘤行UAE治疗的病例进行观察。结果①经MR检查确诊41例单发粘膜下子宫肌瘤的病例，行UAE治疗后随访时间为12～48个月，有31例（75．61％）肌瘤完全消失，7例肌瘤体积缩小93％，以上38例（92．68％）子宫体积恢复至正常大小，3例UAE治疗后6～12个月失访（失访率为7．32％）；②41例中有19例肌瘤经阴道完整排出，其中自然排出6例，钳夹协助排出的13例；有7例部分排出，全部为钳夹协助排出，排出时间为7天～12个月。有12例通过阴道分泌物和排液方式完全排出；③41例患者月经量和贫血明显改善，治疗后38例月经恢复正常，3例月经量过少，治疗后6个月血红蛋白恢复正常；④术前及术后的性激素测定没有差异P〉0．05；⑤UAE治疗后有1例妊娠40周顺产，产后胎盘部分植入引起产后出血再次UAE治疗成功。结论UAE治疗粘膜下子宫肌瘤效果显著而安全。

Objective To explore the effect and prognosis of uterine artery embolization （UAE） on treatment of submucous uterine myoma. Methods A total of 41 patients were retrospectively studied, who were treated by UAE for single submucous uterine myoma in Guangzhou the First Municipal People＇s Hospital from June 2000 to June 2004. Results ① Forty -one women with single submucous uterine myoma were clearly diagnosed by MR imaging test, who were followed up for 12 -48 months after UAE. The fibroids were completely disappeared in 31 cases, 93% decreased in volumes in the other 7 cases, and the uterine volumes of the above 38 recovered to normal size. Three patients were missed, with 7.32% failure rate. ② The fibroids were completely discharged via vagina in 19 cases, 6 of whom discharged spontaneously and 13 discharge by forceps. Seven out of the 41 cases were discharged partially by forceps during 7 days to 12 months after UAE. The other 12 fibroids were discharged by the form of vaginal discharge and fluids. ③ The blood loss of menstruation was decreased obviously in all of the women, with 38 recovered to normal and 3 oligomenorrhea ④ The gonadal hormone were tested before and after UAE and no difference was observed （P〈0. 05）. ⑤ One woman was pregnant after UAE and delivered spontaneously in term. The patient suffered from postpartum hemorrhage for placenta increta and was successfully treated by UAE again. Conclusions UAE is an effective and safety therapy for treatment of submucous uterine myoma.