子宫肌瘤介入治疗中两种不同栓塞剂的对比研究

Two different embolic agents in the treatment of uterine arterial embolization for symptomatic fibroids

目的比较葡聚糖(Dextran)微球与PVA颗粒两种不同栓塞剂经子宫动脉栓塞(UAE)治疗症状性子宫肌瘤的疗效及安全性。方法40例子宫肌瘤患者,肌瘤直径3～12cm。症状有月经量增多,经期延长,部分患者伴有痛经、下腹坠胀、尿路刺激症状及里急后重等。随机分成两组行UAE术,每组20例。一组用PVA颗粒(355～500μm)作栓塞剂,另一组用葡聚糖微球(Sephadex,G-50,100～300μm)作栓塞剂。术后予止痛、抗感染及补液对症处理。记录患者住院天数、栓塞后综合征(尤其是疼痛反应)、随访资料,并相互比较。结果两组患者住院天数,术后疼痛无明显差异。均无严重并发症。平均随访9个月,随访6个月时PVA组和葡聚糖组子宫体积、肌瘤体积分别缩小53.4%、55%和48.6%、40.9%,两组间差异无统计学意义。结论葡聚糖微球栓塞剂与PVA颗粒栓塞治疗症状性子宫肌瘤在临床疗效及安全性方面无差异。前者价格低廉,制备简单。

Objective To compare the efficacy and safety of dextran microspheres and polyvinyl alcohol particles in the uterine arterial embolization （UAE）for symptomatic uterine leiomyomata. Methods Forty women（mean aged 38.5 years, ranged 28-44 years）with symptomatic myomas were randomly divided into two groups with 20 patients in each, PVA （polyvinyl alcohol particles, 355-500 μm）was used as embolic agents in group A and dextran microspheres（Sephadex G-50, 100-300 μm）in group B. The mean diameter of fibroids was 6.5 cm（range, 3-12 cm）with symptoms of menorrahgia, bulk-related symptoms, dysmenorrhea and infertility. Analgesics, anti-infection and rehydration treatments were used after the procedure. The hospital stay, post-embolization syndromes, follow-up materials were reviewed and compared. Results The hospital stay and the post embolization pain showed no obvious difference between the two groups, simultaneously with no serious complications. The average follow-up duration was 9 months （range, 6-24 months）. The average volumes of uterus and fibroid in group A and B decreased gradually during follow-up： 53.4%, 55% and 48.6%, 40.9% ,respectively. Conclusion Dextran microspheres is as the same effective and safe as PVA particles for UAE, but rather cheaper than latter. Further prospective study is warranted.