不同栓塞剂对子宫肌瘤动脉栓塞术后疗效的影响

Effiect of different embolic agents on prognosis of uterine artery embolization in the treatment of uterine fibroid

目的探讨不同种类及规格的栓塞剂对子宫肌瘤动脉栓塞术后疗效的影响。方法选取贵州医科大学第二附属医院、南方医科大学南方医院及广州市第一人民医院1999—2012年因子宫肌瘤使用规格为300—900μm的聚乙烯醇（PVA）、海藻酸钠微球（KMG）及新鲜明胶海绵颗粒（GF）3种栓塞剂行子宫动脉栓塞术（UAE）治疗的296例病例，术前及术后1、3、6个月、1～8年分别观察记录子宫肌瘤体积变化及月经量改变情况。结果（1）不同种类及规格栓塞剂间UAE术后3年内疗效差异无统计学意义。术后4年以上单一使用PVA或KMG的疗效差异有统计学意义（χ^2=4．744，P=0．029）。（2）使用PVA栓塞后加用GF的疗效亦好于单一使用PVA的疗效（χ^2=22．342，P〈0．01），使用KMG栓塞后加用GF的疗效好于单一使用KMG的疗效（χ^2=8．750，P=0．003），而均加用GF后，PVA与KMG的疗效差异无统计学意义（χ^2=0．076，P=0．782）。（3）使用颗粒直径300～500μm的栓塞剂术后4年以上疗效好于〉500～700μm（χ^2=18．674，P〈0．01）及〉700～900μm（χ^2=23．963，P〈0．01）的栓塞剂，而〉500．700μm的栓塞剂疗效与〉700～900μm间差异无统计学意义（χ^2=2．735，P＝0．098）。结论单一使用KMG术后疗效较PVA更好；KMG或PVA与GF联合使用行UAE术后疗效好于单一使用；使用颗粒直径为300—500μm的栓塞剂行UAE术后疗效更佳。

AObjective To investigate the effect of different embolic agents on prognosis of uterine artery embolization （UAE） in the treatment of uterine fibroid. Methods In this study, 296 patients from 1999 to 2012 in the Second Affiliated Hospital of Guizhou Medical University, Nanfang Hospital and Guangzhou First People＇ s Hospital were treated with UAE using PVA, KMG or GF, whose specifications ranged 300～900μm for uterine fibroid. We recorded volume of fibroids and menstrual quantity of the patients before and after operation. Results （1）There was no significant difference among different types and specifications of embolic agents for UAE on efficacy within 3 years after operation. When single embolic agent was applied, KMG was better than PVA for efficacy of UAE 4 years after operation （χ^2=4.744, P= 0.029）. （2）It was better to use GF after PVA（χ^2=22.342, P 〈 0.01） or KMG（χ^2=8.750, P=0.003） than single KMG or PVA embolic agent for efficacy of UAE 4 years after operation. But when we used GF after PVA or KMG, the efficacy was. similar between PVA and KMGO（χ^2=0.076, P=0.782）. （3）It was better to use 300～500μm than 〉 500-700μm（χ^2= 18.674, P 〈 0.01） or 〉 700-900μm（χ^2=23.963 ,P 〈 0.01） of particle diameter of embolic agent for efficacy of UAE 4 years after operation. There was no statistically significant difference on efficacy 4 years after operation between 〉 500～700μm and 〉 700～900μm of particle diameter （χ^2=2.735, P=0.098）. Conclusions KMG is better than PVA when single embolic agent is applied. It is better to use GF after PVA or KMG than single embolie agent for efficacy after UAE. The best particle diameter of embolic agent is 300-500μm.