子宫动脉栓塞术与子宫肌瘤剔除术治疗子宫肌瘤疗效对照研究

Comparison of the clinical efficacy of uterine artery embolization and myomectomy in hysteremyoma

目的比较子宫动脉栓塞术和肌瘤剔除术治疗子宫肌瘤的中远期疗效。方法选择我院2000～2004年住院的子宫肌瘤患者101例,其中51例子宫动脉栓塞术(Uterine artery embolization,UAE),50例肌瘤剔除术(Myomectomy,MYO)。随访时间最短4年,最长7年。回顾患者住院病例和每次随访资料并填写调查问卷。比较两种方法的临床疗效和并发症。结果 UAE组和Myomectomy组比较,盆腔痛和压迫症状缓解率,治疗失败率及并发症发生率无明显差异(P>0.05),月经量多症状改善者UAE组42例(91.3%)明显多于MYO组20例(52.5%)(P<0.01)。UAE组住院天数及应用止痛剂天数与MYO组比较无统计学差异(P>0.05),恢复正常活动天数明显短于MYO组(P<0.01),估计出血量较MYO组明显减少。结论 UAE组和Myomectomy组比较,具有优良的中远期疗效,且有出血少,恢复快,微创等优点,且并未增加术后再手术率,尤其适用于治疗以月经量增多为主要症状的子宫肌瘤;对于以压迫症状为主的子宫肌瘤患者,以选择子宫肌瘤剔除术为宜,应根据患者的主要症状和治疗目的选择合适的治疗方法。

Objective To compare the long and middle effect of treatment with uterine artery embolization and myomectomy.Methods To analyze the outcomes of 101 patients who underwent myomectomy（n=50） or uterine artery embolization（n=51） over 4～7 years period.A questionnaire and review of medical records assessed all procedure-related complications and changes in symptoms.Results The respective observed success rates in myomectomy and uterine artery embolization were 52.5% vs 91.3% for menorrhagia（P0.01）,53.3% vs 76.0% for pain（not significant）,and 90.6% vs 85.7% for mass effect（not significant）.The complication rates were 44.0%（myomectomy） and 45.1%（uterine artery embolization）（P0.05）.The respective secondary end points for the two procedures were 33.17±5.43 vs 8.21±0.68 days until resumption of normal actives（P0.01）,5.67±0.18 vs 5.42±0.36 days mean hospital stay（P0.05）,and 2.02±0.23 vs 2.37±0.49 days of narcotics use（P0.05）.Conclusion Uterine artery embolization is a less invasive and safer treatment option in women with symptomatic leiomyoma than myomectomy.Menorrhagia may be better controlled with embolization,and myomectomy may be a better option in patients with mass effect.