有限性子宫动脉栓塞保护子宫动脉-卵巢动脉吻合

Limited uterine artery embolization and the protection of uterine-ovarian artery anastomosis

目的探讨子宫动脉栓塞时识别与保护子宫动脉-卵巢动脉吻合(UA-OAa)。方法回顾性分析子宫肌瘤与子宫腺肌瘤患者在子宫动脉栓塞(UAE)前后子宫动脉造影显示UA-OAa的DSA资料。结果1056例UAE患者中68例104侧卵巢动脉在栓塞前(后)子宫动脉造影时逆向显影,左侧OA显影47例、右侧OA显影57例,都呈Razavi-I型吻合。20例左侧子宫动脉和27例右侧子宫动脉达到肌瘤动脉栓塞,而UA-OAa保持。68例UAE治疗后在1～2年的追踪期内无一例发生卵巢功能衰竭,33例超声复查其吻合通畅组(n=24例)与吻合阻断组(n=9例)在追踪期间(5.9±3.0,1～12个月)肌瘤缩小率(分别为60.63±23.59%和53.27±28.68%)差异无统计学意义(P>0.05)。结论有限性子宫动脉栓塞可保持UA-OAa,是UAE治疗子宫(腺)肌瘤可供选择的血管造影栓塞终点。

Objective To investigate how to distinguish and to protect the arterial anastomosis between uterine and ovarian arteries （UA-OAa） during the procedure of embolization of uterine artery for hysteromyoma or solenoma. Methods DSA findings in 1 056 patients with hysteromyoma or solenoma, who underwent uterine artery embolization （UAE）, were retrospectively analyzed. A comparison of imaging findings between pre- and post-procedure was made. Results Of 1 056 cases receiving UAE, 104 ovarian arteries were displayed in 68 during uterine artery angiography befBre and/or after embolization, including 47 lett ovarian arteries and 57 right ovarian arteries; in accordance with Razavi-I type utero-ovarian anastomosis. Uterine fibroid embolization was achieved while left （n = 20） and right （n = 27） UA-OAa remained unobstructed. No ovarian failure occurred after UAE in 68 cases during a follow-up of 1 - 2 years. Ultrasound examination showed that there was no statistically significant difference in shrinking ratio of the tumor between UA-OAa obstructed group （n = 9） and UA-OAa unobstructed group （n = 24）. Conclusion Limited uterine artery embolization is an effective technique for the treatment of hysteromyoma and solenoma as it can preserve UA-OAa. （J Intervent Radiol, 2009, 18： 100-103）