子宫动脉栓塞治疗子宫腺肌病效果及影响因素

Uterine artery embolization for the treatment of adenomyosis: its clinical effectiveness and influencing factors

目的探讨子宫动脉栓塞术(UAE)治疗子宫腺肌病的临床效果及影响因素。方法回顾性分析2014年6月至2016年6月采用UAE术治疗的116例子宫腺肌病患者临床资料。随访比较手术前后患者月经期疼痛视觉模拟评分(VAS)、子宫体积、月经量变化,观察治疗总有效率及术后栓塞后综合征、闭经等并发症发生情况,分析疗效影响因素。结果 116例患者治疗总有效率为79.3%(92/116),无效为20.7%(24/116)。术后3、6、9、12个月随访显示,平均VAS评分均较术前明显降低(P<0.05),痛经总缓解率为90.5%(105例);子宫体积较术前分别缩小29.5%、42.4%、48.7%、53.7%,缩小百分率随时间延长而增高;月经量较术前明显减少(P<0.05),月经量完全恢复正常96例(82.8%),减少12例(10.3%),稀少3例(2.6%),闭经5例(4.3%)。术后剧烈腹痛1例(0.9%),高热1例(0.9%),闭经5例(4.3%),并发症总发生率为6.1%。Logistic回归分析显示,手术年龄≥35岁、子宫腺肌病血供类型、子宫动脉卵巢支显影、子宫内膜-肌层交界区(JZ)厚度≥10 mm为UAE术临床疗效独立影响因素[OR(95%CI)值>1,P<0.05]。结论UAE治疗子宫腺肌病效果显著,可有效改善患者月经期疼痛,减少子宫体积及月经量,降低不良反应发生率,值得临床推广应用。

Objective To evaluate the clinical efficacy of uterine artery embolization （UAE） in treating adenomyosis and to discuss the factors affecting curative effect. Methods The clinical data of a total of 116 patients with adenomyosis, who were treated with UAE during the period from June 2014 to June 2016 at authors＂ hospital, were retrospectively analyzed. The visual analogue scale （VAS） score of menstrual pain, uterus volume and menstrual blood volume were recorded, and the postoperative data were compared with the preoperative ones. The total effective rate, post-embolization syndrome, amenorrhea and other complications were documented, and the factors affecting curative effect were analyzed. Results Among the 116 patients, the total effective rate was 79.3% （92/116） and the inefficiency rate was 20.7% （241116）. Regular follow-up was conducted at 3, 6, 9 and 12 months after UAE, the results showed that the mean postoperative VAS score was significantly lower than the preoperative one （P〈0.05）, the total remission rate of dysmenorrbea was 90.5% （n=105）. Compared with the preoperative uterus volume, the postoperative uterus volumes measured at 3, 6, 9 and 12 months after UAE were reduced by 29.5%, 42.4%, 48.7% and 53.7% respectively, with the percentage of shrinkage being increased with time. After UAE, menstrual volume was obviously decreased （P〈O.05）, the menstrual volume returned to normal amount in 96 patients （82.8%）, was decreased in 12 patients （10.3%） and became scant menstrual flow in 3 patients （2.6%）; and 5 patients （4.3%） developed amenorrhea. Severe postoperative abdominal pain occurred in one patient （0.9%）, high fever in one patient （0.9%） and amenolThea in 5 patients （4.3%）. The total incidence of complications was 6.1%. Logistic regression analysis showed that the patient＇s age ≥35 years old, the blood supply type of adenomyosis, the visualization of rami ovarii arteriae uterinae, and the thickness of endometrium-muscularis junctional zone （JZ） ≥ 10 mm were the independent influencing factors for clinical efficacy （OR value： 95%CI〉1, P〈0.05）. Conclusion For the treatment of adenomyosis, UAE carries remarkable clinical efficacy. It can effectively improve menstrual pain, and reduce the uterine volume as well as the ineidence of adverse reactions. Therefore, this technique is worthy of clinical application.