子宫动脉栓塞术治疗子宫腺肌病的中远期临床疗效观察

Intermediate and long term clinical effects of uterine arterial embolization in treatment of adenomyosis

目的探讨子宫动脉栓塞术(UAE)治疗子宫腺肌病(AM)的中远期疗效。方法对189例AM患者行UAE治疗,术前1个月及术后1、2、3、6、12、18个月及以后每年1次随访观察痛经、月经量的变化。结果(1)随访情况:UAE术后具有完整随访资料者168例,随访率88·9%,平均随访时间(50±15)个月。9例患者因痛经治疗无效或复发等原因而切除子宫。(2)痛经症状的变化:168例患者中,159例术前有痛经症状,UAE治疗后131例(82·4%,131/159)为临床有效,28例(17·6%,28/159)为临床无效,8例(5·0%,8/159)复发。AM合并和未合并子宫肌瘤患者的痛经临床有效率分别为92·9%(39/42)、78·6%(92/117),两者比较,差异无统计学意义(P>0·05);局灶型和弥漫型AM患者的痛经临床有效率分别为82·4%(75/91)、82·4%(56/68),两者比较,差异无统计学意义(P>0·05)。(3)月经量的变化:在168例患者中,93例为月经量过多,UAE术后78例月经量恢复正常,10例出现月经量过少,1例出现暂时性闭经,2例月经量无变化,2例出现月经稀少;74例为月经量正常,术后57例月经量无变化,15例出现月经量过少,2例出现子宫性闭经;1例为月经量过少的患者,术后月经量恢复正常。结论UAE治疗AM具有较好的中远期疗效。

Objective To assess the intermediate and long term clinical effectiveness of uterine arterial embolization （UAE） in treatment of adenomyosis. Methods The standard UAE was performed in 189 patients with adenomyosis in our hospital from Jun 1999 to Jun 2004. The fresh gelfoam particles or polyvinyl alcohol particles （PVA） or sodium alginate microspheres for vascular embolization （KMG） mixed with antibiotics were used to embolize the arteries. The degree of dysmenorrhea and amount of menorrhea after the operation were investigated. Results （ 1 ） The number of the cases completely followed up was 168, with a ratio of 88.9%, and a follow-up time of （50 ± 15 ） months. （2） The symptom of dysmenorrhea： in all 168 patients, 159 had dysmenorrhea before the operation. Clinical effectiveness was observed in 82. 4% （131/159） of patients after the operation, but in 17.6% （28/159） of patients there was no clinical effectiveness, and in 5.0% （ 8/159 ） of patients the dysmenorrhea recurred after the operation. （3） The clinical effectiveness between the patients with adenomyosis with and without myoma or between the patients with local and diffuse adenomyosis had no significant difference （ P 〉 0. 05 ）. （4） The amount of menorrhea： in the 93 patients with hypermenorrhea, the amount of menorrhea returned to normal in 83.9% （78/93） , oligomenorrhea occurred in 10. 8% （10/93） , the menorrhea of 2 patients was rare, transient amenorrhea occurred in one ease, and the amount of menorrhea did not change in two patients. Among the 74 patients with normal menorrhea, the menorrhea amount did not change in 77.0% （ 57/74 ） , oligomenorrhea occurred in 20. 3% （15/74） , uterine amenorrhea occurred in two patients. The menorrhea amount of one patient with oligomenorrhea returned to normal after the UAE therapy. （5） Nine patients accepted hysterectomy due to reoccurrence of dysmenorrhea or ineffectiveness or hypermenorrhea. Conclusion UAE has a good intermediate and long term effectiveness in treatment of adenomyosis.