海藻酸钠微球栓塞子宫动脉治疗弥漫型子宫腺肌病的中远期疗效观察

Intermediate and long term clinical effects of uterine arterial embolization with sodium alginate microspheres in treatment of diffuse adenomyosis

目的观察直径500～700μm的海藻酸钠微球（KMG）超选择栓塞子宫动脉，治疗弥漫型子宫腺肌病（AD）的中远期临床疗效。方法选择经药物治疗后无效、自愿接受子宫动脉栓塞术（UAE）治疗的弥漫型AD患者40例，以直径500～700μm的KMG超选择插管栓塞子宫动脉，治疗后3、6、12、24、36、48、60个月随访，分别观察月经量、痛经评分、子宫体积、女性内分泌激素和血清CA。水平变化。结果（1）随访率：40例患者完成了治疗后3、6、12、24个月的随访，随访率为100％；治疗后36、48和60个月的随访例数分别为32、27和23例，随访率分别为80％、68％和58％。（2）临床指标：治疗后3个月，有效率90％（36／40），无效率10％（4／40）；治疗后36个月，有效率88％（28／32），无效率12％（4／32）；治疗后60个月，有效率83％（19／23），无效率17％（4／23），无一例复发。治疗后3个月的月经量、痛经评分、子宫体积分别为（182±8）ml、（46±21）分、（212±35）cm^3，分别与治疗前比较，差异均有统计学意义（P〈0．05）；治疗后6个月的月经量、痛经评分分别为（140±6）ml、（25±16）分，分别与治疗前比较，差异也有统计学意义（P〈0．01）；子宫体积于治疗后12个月时缩至最小，为（135±38）cm^3。（3）血清学指标：治疗后12个月，血清CA。水平下降至最低值，为（56±18）U／L，与治疗前比较，差异有统计学意义（P〈0．01），但始终未下降至正常值；女性内分泌激素水平无明显变化（P〉0．05）。结论直径500～700斗m的KMG超选择栓塞子宫动脉治疗弥漫型AD的中远期疗效满意，对卵巢功能无明显影响。

Objective To study intermediate and long term efficacy of uterine arterial embolization （UAE） with sodium alginate microspheres （KMG） at diameters 500 -700 μm in treatment of diffuse adenomyosis. Methods Totally 40 patients with standard diffuse adenomyosis were enrolled and treated with UAE. KMG at diameters 500 -700 μm for vascular embolization were used to embolize the arteries. The degree of dysmenorrhea, amount of menorrhea and uterine volume, as well as the level of serum CA125, follicle stimulating hormone （FSH） , luteinizing hormone （ LH ）, estradiol （ E2 ） were investigated before and after UAK Results The follow up rates were 100% （40/40）, 100% （40/40） ,80% （32/40） ,68% （27/40）, 58% （23/40） after uterine arterial UAE 12,24,36,48 and 60 months respectively. The early, intermediate and long-term effective rates were 90% （36/40）, 88% （28/32）, 83% （19/23）. The degree of dysmenorrhea, the amount of menorrhea and the uterine volume, as well as serum CA125 all decreased significantly 3 months after UAE at varying degrees （ P 〈 0. 05 ）. Compared with other follow-up time, the degree of dysmenorrhea and the amount of menorrhea declined to their lowest point at 6 month after UAE （P 〈 0. 01 ）. Paralleled with the decrease of volume of uterine, serum CA125 also decreased significantly and reached the lowest level 12 months later compared with other follow-up times（P 〈0. 01 ）. Even at the 12th month after UAE serum CA125 was not normal and FSH, LH and E2 did not change all the times after UAE （ P 〉 0. 05）. No recurrence was found during the 60 months after UAE. Conclusion KMG used in UAE atdiameters 500 - 700 μm has good intermediate and long term effectiveness in treatment of diffuse adenomyosis with no side effects.