子宫动脉栓塞治疗子宫肌瘤的动态影像学监测及其机制研究

Uterine arterial embolization for the treatment of uterine leiomyomas:its dynamic imaging monitoring and therapeutic mechanism

目的观察子宫动脉栓塞治疗子宫肌瘤术前、术后影像学动态变化,探讨其治疗机制。方法通过对45例子宫肌瘤患者行子宫动脉栓塞治疗,观察栓塞前后行盆腔彩色多普勒超声(彩超)、MR平扫加增强,以及栓塞后CT平扫检查,了解子宫及肌瘤影像学征象的动态变化。追踪时间3～16个月,平均(10.0±3.5)个月。结果术前41例彩超显示肌瘤血流丰富,术后第1天肌瘤和正常肌层血流消失,第7天肌瘤血流仍消失但正常子宫肌层血流开始出现;术后1、3、12个月正常子宫肌层血流恢复正常而肌瘤内仍无血流。4例术后第7天开始肌瘤内有血流信号,至术后12个月肌瘤内仍有血供。45例CT平扫发现术后当天肌瘤和正常肌层均有碘油沉积,以肌瘤明显,术后1、3、12个月正常子宫肌层碘油逐渐流失,而肌瘤内仍有碘油沉积。45例术前MRI肌瘤及子宫肌层均有明显强化,术后3个月MRI复查39例肌层有强化而肌瘤无强化改变;另6例术后肌瘤仍有不同程度强化。2例患者术后肌瘤脱落,病理证实为坏死组织。术前、术后肌瘤体积变化的监测,MRI与彩超测量结果的比较差异无统计学意义(P>0.05)。结论子宫肌瘤血管床出现选择性栓塞导致肌瘤坏死,是子宫动脉栓塞治疗子宫肌瘤的机制。其动态影像学监测随访,以彩超为首选手段。

Objective To study the dynamic imaging changes of the uterine leiomyomas before and after uterine arterial embolization（UAE） treatment and to discuss its therapeutic mechanism.Methods Color Doppler sonography and both plain and enhanced MRI scanning were performed in 45 patients with uterine leiomyomas before and after UAE.Plain CT scan was performed in all patients after UAE.All the patients were followed up for 3-16 months（average 10 ± 3.5 months）.Results In 41 of the total 45 cases, the color Doppler sonography showed rich blood flow signals in leiomyomas and myometrium before UAE and no or less blood flow signals in both leiomyomas and myometrium on the first day after UAE.On the seventh day, the blood flow signal was still absent in leiomyomas while it was restored in myometrium, and the same phenomena remained in the first, the third and the twelfth month after UAE.In the other four cases, color Doppler sonography demonstrated blood flow signals inside leiomyomas on the seventh day after UAE and it remained till twelve months after embolization.The embolic agent（Lipiodol） was found in both leiomyomas and myometrium on CT scan for 45 cases on the first day of UAE.CT scan also showed the deposit of the Lipiodol in myometrium, but Lipiodol gradually vanished in leiomyomas at one, three and the twelve months after UAE.The enhancement was apparent in leiomyomas and myometrium on MRI scan in all 45 cases before UAE.The enhancement was found in the myometrium, but not in leiomyomas, on MRI scan in 39 cases 3 months after UAE.The other six cases demonstrated different degrees of enhancement in leiomyomas after embolization.In two cases the detachment of the leiomyomas were observed after embolization and the desquamating materials were pathologically proved to be necrotic tissue.The difference in the measuring data about leiomyoma volume between MRI and color Doppler sonography was of no statistical significance（P 0.05）.Conclusion The therapeutic mechanism of UAE for uterine leiomyomas is selectively embolizing the vascular bed of uterus, leading to subsequent necrosis of leiomyomas.The color Doppler sonography should be the first choice for the dynamic imaging follow-up after UAE.