选择性子宫动脉栓塞术对症状性子宫肌瘤的治疗作用

Effect of Selective Uterine Artery Embolization on Symptomatic Uterine Fibroids

目的观察选择性子宫动脉栓塞术(selective uterine artery embolization,SUAE)治疗症状性子宫肌瘤的疗效。方法 2007年2月～2009年6月,对34例症状性子宫肌瘤行选择性双侧子宫动脉栓塞术。肌壁间肌瘤31例,黏膜下肌瘤3例;单发29例,多发5例;肌瘤直径4～8.5 cm,平均5.3 cm。32例合并贫血,血红蛋白49～101 g/L。术前及术后3、6、12个月采用月经失血图(pictorial blood loss assessment chart,PBAC)评估月经量,检测血红蛋白值,B超测量子宫及肌瘤体积。结果栓塞成功率100%。3例黏膜下子宫肌瘤分别于术后31天、43天及52天坏死脱出宫颈外口,予以摘除。1例肌壁间肌瘤患者于术后10个月受孕。30例肌壁间肌瘤患者术后3个月月经量评分由术前162.4±22.6下降至87.8±13.4(t=18.325,P=0.000),12个月降至34.3±10.8(t=25.380,P=0.000);血红蛋白术前为(76.5±11.7)g/L,术后6个月及12个月分别上升至(103.7±7.3)g/L(t=-10.994,P=0.000),(109.5±5.8)g/L(t=-12.338,P=0.000);子宫及肌瘤体积自术后6个月显著逐渐缩小,子宫体积术前(266.3±49.3)cm3,术后6个月缩小至(175.6±53.4)cm3(t=9.047,P=0.000),12个月缩小至(135.3±44.2)cm3(t=11.036,P=0.000);肌瘤体积术前(101.5±23.4)cm3,术后6个月缩小至(54.1±16.7)cm3(t=9.888,P=0.000),12个月缩小至(35.6±11.5)cm3(t=14.119,P=0.000)。结论 SUAE能有效减少子宫肌瘤患者月经量,改善贫血,缩小子宫及肌瘤体积,且能保留女性生育能力,是治疗症状性子宫肌瘤安全、有效、微创的方法。

Objective To evaluate the efficacy of selective uterine artery embolization（SUAE） in the treatment of symptomatic uterine fibroids. Methods SUAE were performed on 34 patients with symptomatic uterine fibroids from Feburary 2007 to June 2009.There were 31 cases of intramural myoma and 3 cases of submucous myoma.Mono-myoma was found in 29 patients,and multi-myoma in 5 patients.The diameter of the fibroids was 4-8.5 cm with a mean of 5.3 cm.32 cases were complicated with anemia with the level of hemoglobin at 49-101 g/L.The menstrual blood volume were observed and assessed by pictorial blood loss assessment chart（PBAC）,and hemoglobin concentration,volumes of uterine and uterine fibroids were determined preoperation and 3,6,and 12 months post-SUAE. Results SUAE was completed successfully in all the patients.In the 3 cases of submucous myoma,the necrotic tumor prolapsed out of the os and then was removed at days 31,43,and 52 respectively.One case of intramural myoma conceived 10 months after SUAE.The mean score of menstrual blood volume of 30 of the patients was 162.4±22.6 before SUAE,and declined to 87.8±13.4（t=18.325,P=0.000） and 34.3±10.8（t=25.380,P=0.000） on the 3rd and 12th month after SUAE,respectively.The hemoglobin concentration was（76.5±11.7） g/L before SUAE,and then increased to（103.7±7.3） g/L（t=-10.994,P=0.000） and（109.5±5.8） g/L（t=-12.338,P=0.000） on the 6th and 12th month after SUAE,respectively.The uterine volume was（266.3±49.3） cm3 before SUAE,and decreased to（175.6±53.4） cm3（t=9.047,P=0.000） and（135.3±44.2） cm3（t=11.036,P=0.000） on the 6th and 12th month after SUAE,respectively.The uterine fibroids volume was（101.5±23.4） cm3 before SUAE,and decreased to（54.1±16.7） cm3（t=9.888,P=0.000） and（35.6±11.5） cm3（t=14.119,P=0.000） on the 6th and 12th month after SUAE,respectively. Conclusions SUAE can effectively decrease menstrual blood volume,improve anemia,reduce the volume of uterine fibroids,and preserve fecundity.It is a safe,effective and minimally invasive treatment for symptomatic uterine fibroids.