几种栓塞剂介入栓塞子治疗子宫肌瘤的临床研究

Comparison of different embolism agents in the uterine arterial embolization therapy for leiomyoma of uterus

目的:探讨不同栓塞剂行子宫动脉栓塞术(UAE)治疗子宫肌瘤后的疗效、不良反应及并发症。方法:129例子宫肌瘤患者行选择性双侧子宫动脉插管造影栓塞治疗。将患者按所用栓塞材料分为四组:真丝线段组(SS组,32例)、明胶海绵组(GS组,35例)、聚乙烯醇组(PVA组,30例)和平阳霉素碘油乳剂+明胶海绵组(PLE组,32例)。术后随访6个月,观察临床症状改变、肌瘤大小变化、术后副反应及并发症。结果:四组患者贫血、月经量多、压迫症状均有不同程度改善。UAE后6个月,四组患者肌瘤均有不同程度减小,SS组由治疗前的(91.21±67.54)mm缩小到(39.39±11.09)mm(t=4.019 7,P<0.01),GS组由(95.33±71.13)mm缩小到(41.17±10.65)mm(t=4.386 1,P<0.01),PVA组由(89.93±65.32)mm缩小到(34.36±11.75)mm(t=4.586 1,P<0.01),PLE组由(92.56±62.19)mm缩小到(34.02±14.63)mm(t=5.184 3,P<0.01)。PVA组和PLE组肌瘤体积减小程度较GS组明显,但术后下腹坠痛此二组又明显高于GS组和SS组(P=0.032 4),而其他副反应及并发症四组间差异无显著性(P>0.05)。结论:真丝线段和平阳霉素碘油乳剂+明胶海绵颗粒行动脉介入栓塞治疗子宫肌瘤具有良好的疗效和安全性,可作为PVA的替代物。

Objective： To investigate the effectiveness,side effects and complications of uterine artery embolization（UAE） for uterine leiomyoma using different embolism agents.Methods： A total of 129 patients underwent UAE,which were randomly distributed to four groups,by using natural silk segment（Group SS,32 patients）,gelatin sponge paricles（Group GS,35 patients）,polyvinyl alcohol（Group PVA,30 patients） and GS-pingyangmycin lipiodol emulsion（Group PLE,32 patients）.With 6 months of follow up,the clinical symptoms,tumor volumes,postoperative side effects and complications were observed,respectively.Results： There were no significant difference among the four groups for the melioration rates of anemia,menstrual cycle and oppression symptoms,as well as the some incidence of side-effect and complication（P〉0.05）,but the volumes of uterine leiomyoma at sixth month after UAE with PVA and PLE were more decreased than those of Group GS.The leiomyoma volume of Group SS was from（91.21±67.54）mm decrease to（39.39±11.09）mm（t=4.019 7,P〈0.01） in six months,Group GS from（95.33±71.13）mm to（41.17±10.65）mm（t=4.386 1,P〈0.01）,Group PVA from（89.93±65.32）mm to（34.36±11.75）mm（t=4.586 1,P〈0.01）,and Group PLE from（92.56±62.19）mm to（34.02±14.63）mm（t=5.184 3,P〈0.01）.Otherwise the pain in lower abdomen was also frequently seen in patients using PVA and PLE.Conclusion： Both silk segment and gelatin sponge with pingyangmycin lipiodol emulsion has an approximate effect in UAE,which can replace PVA as a good agent of arterial embolization.