子宫肌瘤栓塞治疗后闭经的临床分析

Amenorrhea after Uterine Fibroid Embolization:A Report of Six Cases

背景与目的:子宫肌瘤的栓塞治疗是子宫肌瘤的治疗方法之一,但存在治疗后闭经的问题。本研究探讨子宫肌瘤栓塞治疗后发生闭经的原因。方法:对在中山大学附属第一医院行子宫肌瘤栓塞治疗的487例患者追踪随访1年观察闭经的发生情况。所有病例均采用双侧子宫动脉插管经导管注入栓塞剂方法,其中104例以超液化碘油加平阳霉素作为栓塞剂,栓塞剂用量超液化碘油8～15mL(平均10mL)、平阳霉素6～16mg(平均8mg);158例以聚乙烯醇作为栓塞剂,用量80～150mg(平均100mg);225例以明胶海绵作为栓塞剂,用量1～2g(平均1.5g)。结果:栓塞后临床有效率为98.97%(482/487);栓塞失败率1.03%(5/487)。栓塞后共有6(1.23%)例出现闭经,其中碘油组3例,碘油在卵巢区沉积;聚乙烯醇组1例;明胶海绵组2例。除明胶海绵组1例外,其余5例均出现雌二醇下降,促卵泡生成素上升。另外1例经多次超声检查发现子宫内膜仅3mm,而雌二醇和促卵泡生成素正常,宫腔镜证实为内膜萎缩。结论:常用的栓塞材料均有可能导致子宫肌瘤栓塞后闭经,子宫肌瘤栓塞后闭经发生率为1.23%,其原因与卵巢受损和子宫内膜受损萎缩有关。

BACKGROUND ＆ OBJECTIVE： Uterine fibroid embolization is an effective treatment alternative for uterine fibroids. However, amenorrhea after uterine fibroid embolization occurs in some patients. This study was to investigate the causes of amenorrhea after uterine fibroid embolization. METHODS Bilateral transcatheter uterine artery embolization was performed in 487 patients with uterine fibroids. Pingyangmycin （6-16 rag） dispersed in lipiodol （8-15 mL） was used as embolic agent in 104 patients; polyvinyl alcohol （80-150 rag） was used in 158 patients; absorbable gelatin sponge （1-2 g） was used in 225 patients. All patients had been followed up for 1 year to observe amenorrhea occurrence. RESULTS. Uterine fibroid embolization was effective in 483 （98.97%） patients, but failed in five （1.03%） patients. Amenorrhea after embolization was found in six （1.23%） patients. Of the six patients, three were in lipiodol plus pingyangmycin group with lipiodol deposited in the ovarian region, one was in polyvinyl alcohol group and the other two were in absorbable gelatin group. Except for one patient in absorbable gelatin group, the rest five patients had estradiol （E2） decreasing and follicle stimulating hormone （FSH） rising due to ovarian function failure. In absorbable gelatin group, multiple ultrasonography examinations revealed that the endometrium was only 3 mm thick in one amenorrhea patient who had normal levels of E2 and FSH, and hysteroscope examination confirmed endometrial atrophy in this patient. CONCLUSIONS. Routine embolic agents have the chance in inducing amenorrhea after uterine fibroid embolization. The occurrence rate of amenorrhea after uterine fibroid embolization is about 1.23%. Ovarian function failure and endometrial atrophy are the most related factors.