微创X线引导下不同栓塞剂介入治疗子宫肌瘤疗效比较

Effect Comparison of Uterine Arterial Embolization with Different Embolism Agents under Xray Guide for Uterine Fibroids

目的比较微创X线引导下不同栓塞剂介入治疗子宫肌瘤的疗效,为临床选择合适的栓塞剂提供依据。方法 480例子宫肌瘤患者在X线引导下行选择性双侧子宫动脉栓塞治疗,按所选择的栓塞材料不同将其分为三组:真丝线段(natural silk segment,SS)栓塞组159例,聚乙烯醇(polyvinyl alcohol,PVA)栓塞组163例,平阳霉素(pingyangmycin,PLE)碘油乳剂+明胶海绵栓塞组158例,采用Seldinger技术行双侧子宫动脉栓塞介入治疗。术后随访1年,比较三组患者临床症状改变、肌瘤体积变化、有效率、术后不良反应及并发症。结果三组患者治疗后子宫肌瘤体积较治疗前明显缩小(P<0.05),月经量与月经周期、压迫症状、腹痛、贫血等临床症状均明显改善(P<0.05),而组间肌瘤体积、临床症状率比较,差异无统计学意义(P>0.05)。SS组、PVA组及PLE组术后3个月有效率分别为90.6%、96.9%和96.8%,术后6个月分别为94.3%、96.9%和93.7%,组间比较差异无统计学意义(P>0.05)。术后缺血性盆腔疼痛及发热为主要不良反应,无子宫坏死等严重并发症。三组患者术后并发症率比较,差异无统计学意义(P>0.05)。结论 SS、PVP、PLE三种栓塞剂行子宫动脉栓塞治疗子宫肌瘤在近期临床疗效及安全性方面相当,远期疗效尚待进一步观察。

Objective To compare the effect of uterine arterial embolization（ UAE） with different embolism agents under X-ray guide for the treatment of uterine fibroids. Methods A total of 480 hysteromyoma patients treated by selective bilateral UAE were analyzed retrospectively. According to the different embolism materials,they were divided into 3 groups： 159 cases performed UAE with silk suture（ natural silk segment,SS） regarded as SS group,163 cases with polyvinyl alcohol（ PVA） as PVA group,and158 cases with pingyangmycin（ PLE）,emulsion of iodine oil plus gelfoam as PLE group. The UAE was applied Seldinger technique under X-ray guidance in all patients. After 1 year follow-up,the clinical symptoms,fibroid volume,effective rate and postoperative adverse reaction were analyzed among three groups.Results The uterine fibroids volume were significantly reduced,and the symptoms such as menstrual blood volume,menstrual cycle,compression,abdominal pain,anemia and other clinical symptoms were improved obviously after the UAE than those before UAE（ P〈0. 05）,but there was no statistical difference in fibroid volume and clinical symptom rate among three groups（ P〉0. 05）. The effective rate was90. 6 %,96. 9 %,96. 8 % respectively 3 months after UAE and 94. 3 %,96. 9 %,93. 7 % respectively6 months after UAE in SS goup,PVA group and PLE group,there were no statistical difference among three groups（ P〉0. 05）. Except the symptoms of ischemic pelvic pain and fever,no serious complications such as uterine necrosis were found. There was no statistical difference in postoperative complication among three groups（ P〉0. 05） Conclusion The UAE with different embolism materials as SS,PVP and PLE can achieve safe and effective outcomes for uterine fibroids without serious post-operative complications,but long-term clinical efficacy remains to be further defined.