超声造影评估子宫动脉栓塞术治疗子宫肌瘤疗效的应用价值

The application of contrast-enhanced ultrasound in evaluating the curative effect of uterine artery embolization for fibroids

目的探讨超声造影评估子宫动脉栓塞术(UAE)治疗子宫肌瘤疗效的应用价值。方法明确诊断为子宫肌瘤的患者63例,共有肌瘤79个,长径为3~10cm,其中子宫体肌瘤74个、子宫颈肌瘤3个、阔韧带肌瘤2个,均行UAE。63例患者(51例富血供,12例乏血供)于术前、术后1周,1、3、6个月行超声造影,随访指标:肌瘤体积缩小情况,症状改善情况(月经量增多、经期紊乱、痛经、压迫症状),超声造影表现变化情况。结果51例富血供组子宫肌瘤从术后1周体积开始缩小,且随着时间延长而不断缩小;12例乏血供组肌瘤从术后1月才开始缩小,也随着时间延长而不断缩小。术前、术后超声造影变化情况及临床症状改善情况对比差异均无统计学意义。结论富血供子宫肌瘤UAE术后1周体积即开始缩小,乏血供肌瘤术后1个月才开始缩小,但远期疗效基本一致。子宫肌瘤UAE术前术后均具有独特的超声造影表现,临床可据此评估UAE治疗子宫肌瘤的疗效。

Objective To discuss the application of contrast - enhanced ultrasound in evaluating the curative effect of uterine artery embolization (UAE) for fibroids.Methods A total of 63 patients with confirmed fibroids were enrolled in this study.A total of 79 fibroid lesions were detected.The size of fibroids ranged from 3 cm to 10 cm.The fibroids were located at uterine body (n=74),at cervix uterus (n=3) or at broad ligament (n=2).UAE was carried out in all patients.Of the 63 patients,fibroid with rich blood supply was seen in 51 (rich blood supply group) and fibroid with poor blood supply in 12 (poor blood supply group).Contrastenhanced ultrasonography was performed before UAE as well as one week,one,3 and 6 months after UAE. The follow-up indexes included volume reduction of fibroids,improvement of symptoms (increase in menstrual volume,menstrual disorder,dysmenorrhea and compression) and changes in contrast - enhanced ultrasonographic findings.Results In the rich blood supply group,in one week after UAE the volume of fibroids began to shrink,and the volume continued to shrink over time.In the poor blood supply group,the volume of fibroids began to shrink in one month after UAE,and the reduction in fibroids volume went on along with the time.No statistically significant differences in contrast- enhanced ultrasonographic findings and the improvement of clinical symptoms existed between the preoperative data and postoperative ones. Conclusion The volume of fibroids with rich blood supply begins to shrink in one week after UAE,while the volume of fibroids with poor blood supply begins to shrink in one month after UAE.The long - term curative effect of UAE is basically the same for fibroids with rich blood supply and for fibroids with poor blood supply.Clinically,the reduction of fibroids volume can be used to evaluate the curative effect of UAE for fibroids.