子宫动脉栓塞术治疗症状性子宫肌瘤的中远期疗效分析

The Clinical Efficacy of Uterine Artery Embolization in the Treatment of Symptomatic Uterine Fibroids During Mid-Long-Term Follow-up

目的探讨子宫动脉栓塞术(UAE)治疗症状性子宫肌瘤的中远期临床效果。方法回顾性分析2012年1月至2016年5月在本院就诊的152例自愿接受UAE治疗的症状性子宫肌瘤患者,症状包括月经量增多,经期延长,不孕、下腹痛、尿频及邻近器官压迫等。平均年龄(42.11±6.35)岁。所有患者均在DSA下行双侧子宫动脉造影并UAE治疗。术后随访1~6年,记录术后1年子宫肌瘤大小变化、卵巢功能变化、贫血程度及肌瘤治疗总有效率。统计术后3年肌瘤治疗总有效率及子宫肌瘤症状和健康相关生活质量问卷(UFS-QOL)评分。统计有生育要求无避孕措施患者术后6年内妊娠情况。结果术后1年肌瘤体积较术前明显缩小,差异有统计学意义(P<0.05);血红蛋白(HB)水平均较术前有不同程度的提高,差异有统计学意义(P<0.05);血清黄体生成素(LH)、卵泡刺激素(FSH)水平均无明显变化,差异无统计学意义。术后1年肌瘤治疗总有效率为92.7%,术后3年总有效率略下降,为77.9%。术后3年UFS-QOL症状评分较术前明显下降,差异有统计学意义(P<0.05)。术后6年内妊娠发生率为54.5%,成功妊娠至分娩的发生率为75.0%。结论 UAE治疗症状性子宫肌瘤创伤小、恢复快,并且术后对卵巢功能影响较小;长期随访,明显改善生活质量且妊娠率较高,有广泛的应用前景。

Objective To investigate the clinical efficacy of uterine artery embolization(UAE)in the treatment of symptomatic uterine fibroids.Methods 152 patients with symptomatic uterine fibroids were included in this study,who received uterine artery embolization from January 2012 to May 2016 in our hospital.The main symptoms included menorrhagia,delayed menstruation,lower abdominal pain,infertility and pelvic pressure symptoms such as frequent urination.The mean age was 42.11±6.35(21-55)years.All patients underwent bilateral uterine artery angiography and embolization.The volume of the uterine fibroids,ovarian function,hemoglobin,and total effective rate of treatment at 1 year after UAE was recorded.The total effective rate of treatment and UFS-QOL symptom scores were recorded 3 years after UAE.During the follow-up periods,pregnancy rate was 54.5%and successful pregnancy rate with live birth was 75%.Results The volume of uterine leiomyoma was significantly smaller than pre-embolisation(P<0.05);hemoglobin levels showed a significant advantage over preoperative levels(P<0.05).There was no statistical significance in serum LH and FSH compared with preoperative levels(P>0.05).The total effective rate of treatment was 92.7%、77.9%respectively 1 year and 3 years after UAE.The UFS-QOL symptom score decreased significantly after embolisation for 3 years follow-up,and the difference was statistically significant(P<0.05).Conclusion UAE is an effective and less invasive method for symptomatic uterine fibroids with rapid recovery and less effect on the ovary and obvious improvement of QOL symptom score.It thus appears to be a feasible and promising approach to the treatment of symptomatic uterine fibroids.