子宫动脉栓塞术治疗子宫腺肌病痛经疗效评判时间点的研究

Evaluation Time Points of Uterine Artery Embolization in the Treatment of Symptomatic Adenomyosis

目的探讨子宫动脉栓塞术（uterine artery embolization,UAE）治疗子宫腺肌病痛经症状的疗效评判时间点。方法选择2007年1月~2014年1月有痛经症状并且经MRI检查诊断为子宫腺肌病的患者59例。使用视觉模拟量表（visual analog scale,VAS）评价痛经程度,使用重复测量方差分析和广义估计方程比较UAE术前及术后1、3、6、12个月时痛经情况和有效率。结果 1术前痛经VAS为（8.1±2.5）分,术后1、3、6、12个月痛经VAS分别为（3.7±3.7）分、（3.4±3.2）分、（2.7±3.0）分和（2.9±3.2）分。术后各评判时间点痛经程度对比术前均有下降（P=0.000）。术后3个月较术后1个月略下降,无统计学差异;术后6个月痛经程度明显轻于术后1、3个月,而与术后12个月比较无统计学差异。2术后1、3、6、12个月有效率分别为67.8%（40/59）、71.2%（42/59）、79.7%（47/59）和74.6%（44/59）,各时间点间有效率无明显差异,术后6个月时UAE治疗有效率最高。结论术后6个月时痛经缓解程度达到最高峰后维持稳定,是评价子宫腺肌病UAE术后痛经疗效最佳时间点。

Objective To investigate the optimum of evaluation time points of uterine artery embolization （ UAE ） in the treatment of dysmenorrheal due to adenomyosis . Methods The study included 59 patient with symptomatic uterine adenomyosis diagnosed by magnetic resonance imaging and receiving UAE between January 2007 and January 2014.The visual analog scale （ VAS） was used to evaluate the degree of dysmenorrhea and the VAS scores of dysmenorrhea were compared at preoperative and 1, 3, 6, and 12 months postoperative time points by using ANOVA for repeated measurements . Results ①The VAS scores of dysmenorrhea was 8.1 ±2.5 preoperatively, and 3.7 ±3.7, 3.4 ±3.2, 2.7 ±3.0, and 2.9 ±3.2 points at 1, 3, 6, and 12 months postoperatively. The VAS scores of dysmenorrhea was lower postoperatively than preoperatively （P=0.000）.There were no statistical differences in VAS scores between 3 months and 1 month after UAE .The VAS scores at 6 months after UAE were significantly lower than that at 1 months and 3 months but comparable to the scores at 12 months.②The effective rates at 1, 3, 6, and 12 months after UAE treatment were 67.8%（40/59）, 71.2%（42/59）, 79.7%（47/59）, and 74.6%（44/59）, respectively, without significant differences in efficiency among these time points .The highest efficiency rate was achieved at 6 months after UAE treatment . Conclusions After treatment of UAE, the remission of dysmenorrhea obtains the most effective results at 6 postoperative months and stays in a low level . The optimum evaluation time of UAE in the treatment of symptomatic adenomyosis is at 6 months after treatment .