子宫动脉分次栓塞治疗巨大子宫肌瘤临床分析

The clinical application of selective uterine artery embolization in the treatment of large uterine fibroids

目的:探讨分次栓塞子宫动脉治疗巨大子宫肌瘤的方法和临床疗效。方法:对18例巨大子宫肌瘤患者进行选择性子宫动脉造影及栓塞治疗。治疗前观察其子宫肌瘤血供特点、瘤体大小;其中10例栓塞材料用自制真丝线段颗粒(7号手术缝线),8例用聚乙烯醇微粒(PVA,300～500!m)及明胶海绵颗粒栓塞子宫动脉,栓塞治疗后造影证实子宫动脉栓塞的变化情况并随访。结果:血管造影显示子宫肌瘤血液供应丰富,主要由子宫动脉供血,左侧为主的7例(约占39%),右侧为主的10例(约占56%),双侧接近相同供血的1例(约占5%)。随访18例患者,随诊5年超声检查结果,子宫及肌瘤体积均明显缩小,子宫体积缩小33.7%～51.6%,肌瘤体积缩小48.3%～75.8%(P<0.01),5年内未发现术后再发肌瘤。结论:采用两次子宫动脉栓塞,使用普通导管、真丝线段栓塞经济有效;使用微导管采用远端聚乙烯微球近端加明胶海绵颗粒确切安全,疼痛等症状明显较一次栓塞轻,疗效好。

Objective To evaluate the clinical effects of two-setp selection uterine artery embolization on large uterine fibroids. Methods Selective artery embolization was performed on 18 patients with large uterine fibroids. Features of the blood supply for uterine fibroids and the tumor sizes were observed before treatment, The self-made silk microspheres （7^# suture） were used in 10 patients, and polyvinyl alcohol （PVA, 300 - 500 μm） and gelfoam microspheres were applied in another 8. The changes in uterine arteries after embolization were detected by arterial angiography. A followed-up was conducted for 1 to 5 years. Results Arterial angiography showed that the blood supply to uterine fibroids was affluent, which was mainly provided by uterine artery. 7 cases （approximate 39%） were supplied from the left, 10 （about 56%） from the right,and 1 （5%） from bilateral uterine artery. All of the patients were followed by ultrasound. Both of the uterine and uterine fibroids in all patients were evidently shrunk （P 〈 0.01 ）, with a （33.7% - 51.6%） and a （48.3% - 75.8%） of reduction in size, respectively, during the 5 years of follow-up. No recurrence was found. Conclusion Dual uterine artery embolization with distal PVA blockage and proximal gelfoam microspheres blockage or the self-made silk microspheres （7^# suhure） is safe and effective in the treatment of large uterine fibroids.