盆腔出血性疾病卵巢动脉栓塞治疗

Pelvis hemorrhagic lesion with ovarian arterial supply:treatment by transcatheter arterial embolization

目的评价盆腔出血性疾病经导管栓塞卵巢动脉(OVA)的疗效和安全性。方法对12例OVA参与盆腔出血性疾病供血的患者进行选择性OVA栓塞术,在栓塞OVA之前均曾行常规髂内动脉前支-子宫动脉栓塞术。出血的病因包括产后出血6例,盆腔血管畸形2例,子宫肌瘤、子宫颈癌、子宫肌瘤术后、盆腔纤维肉瘤各1例。12例中,7例于第1次介入治疗栓塞两侧髂内动脉-子宫动脉后未能控制出血,第2次造影显示OVA参与出血的供血,5例于栓塞两侧髂内动脉-子宫动脉后发现OVA参与病变供血。栓塞OVA的材料用PVA3例、PVA+明胶海绵颗粒7例、PVA+明胶海绵颗粒+微型钢圈2例。结果选择性OVA造影显示对比剂外溢至宫腔(盆腔)10例、OVA参与病变供血2例,未显示髂内动脉和其他侧支参与供血。选择性栓塞OVA的技术成功率为100%,包括栓塞两侧OVA者4例、单侧者8例,未发生与栓塞术相关的并发症。12例患者经补充栓塞参与出血或病变的OVA后出血立即停止,住院期间未再复发出血。术后随访2周～36个月,3例术后2～3周子宫切除,1例盆腔纤维肉瘤术后接受放射治疗,1例盆腔动静脉畸形出院后仍有间歇少量阴道出血、未特殊处理,2例出现一过性卵巢功能减退症状,分别于术后3、4个月恢复正常月经。其余7例在随访期间未复发出血、月经周期正常。结论OVA可参与盆腔出血性疾病的供血,是导致常规栓塞两侧髂内动脉-子宫动脉不能控制出血的原因之一。如发现OVA参与盆腔出血性病变的供血,补充做OVA栓塞术是安全和有效的。

Objective To evaluate the safety and efficacy of transcatheter arterial embolization（TAE）of the ovarian arteries （OVA）for management of the pelvic hemorrhagic lesions with OVA supply. Methods Twelve patients with pelvic, hemorrhagic lesions underwent selective OVA embolization in addition to the routine TAE of the hypogastric-uterine arteries. Patients mean age was 41 years old（range, 24 - 58 years）. The causes of bleeding included postpartum hemorrhage in 6 cases, pelvic arteriovenous malformations（AVM）in 2, uterine fibroids in 1, cervix carcinoma in 1, post-operation for fibroids in 1, and pelvic fibrosarcoma in 1 patient. Seven patients with clinical failure after the bilateral hypogastric-uterine arterial embolization, underwent a second angiogram demonstrating the ovarian arterial bleeding. Five patients were identified additional blood supply to the pelvic lesions from the ovarian arteries after the bilateral hypogastric-uterine arterial embolization. The embolization materials were consisted of polyvinyl alcohol particles （PVA）in 3 patients, PVA and gelatin sponge particles in 7; and PVA with gelatin sponge particles accompanied by microcoils in 2 cases. Results Selective angiography of the OVA revealed contrast extravasation in 10 and blood supply to the pelvic lesions via OVA in 2 patients, without evidence of the blood supply from other sources. Technical success of the OVA embolization was achieved in all cases, including unilateral in 8 and bilateral in 4 cases. No major complications related to the procedure were found. All bleeding ceased immediately after supplemental OVA embolization. Recurrent bleeding did not occur in any of the cases during their hospital stay. Follow-up time ranged from 2 wk - 36 mo. Hysterectomy was performed in 3 patients during 2 - 3 wk after the procedure. One patient with pelvic fibrosarcoma received radiotherapy at 3rd wk after the embolization. One patient with pelvic AVM experienced minor vaginal bleeding intermittently after the embolization but without further intervention. Two patients developed transient symptoms of ovarian dysfunction, and their normal menstruations resumed at 3 and 4 months respectively pest-procedurelly. Both re- bleeding and ovarian dysfunction did not occur in the rest 7 patients. Conclusions Pelvic hemorrhagic lesions with OVA blood supply may result in clinical failure following the bilateral hypogastric-uterine arterial embolization. Selective OVA embolization is a safe and effective adjunct for the further management. （J Intervent Radiol, 2007, 16： 606-610）