子宫动脉栓塞术中动脉痉挛的防治

Prevention of Vasospasm in Uterine Arterial Embolization

目的 分析子宫动脉栓塞术 (UAE)中子宫动脉痉挛 (UAS)的原因及防治。资料与方法 118例子宫肌瘤患者行 2 37条子宫动脉 (UA)超选择插管造影 (1例为双UA)。将UAS分为轻、中、重三度 :痉挛使动脉管腔狭窄 <30 %为轻度 ,30 %～ 6 0 %为中度 ,>6 0 %为重度。统计UAS的数目、部位及程度。中、重度以上的UAS经动脉内注入罂粟碱。结果 插管过程中 85条UA出现痉挛 ,占 36 %。轻度 5 2条占UAS总数的 6 1.1% ,中度 2 1条 ,占2 4 .7% ,重度 12条 ,占 14 .1% ,2条中度痉挛的UA在注射PVA时主干自痉挛处闭塞 ,重度中完全闭塞 3条 ,出现夹层 2条。对 33条中、重度UAS采用动脉内推注罂粟碱 ,31条痉挛解除 ,管径恢复正常 ,2条无效。结论 UAS是造成UAE失败的重要原因 。

Objective To analyze the cause and management of uterine arterial spasm (UAS) during uterine arterial embolization.Materials and Methods 118 patients with uterine myomas were performed transluminal arterial embolization in 237 arteries (dual uterine arteries in one cases). Uterine arterial spasm was defined as three types of degree: luminal stenosis less than 30% as mild spasm, 30%～60% as moderate spasm, over 60% as severe spasm. And the number, location and degree of vasospasm were analyzed. Papaverine was injected into artery when the spasm was observed over 30%. Results UAS was found in 85 arteries (36%), including 52 arteries with mild spasm (61.1%), 21 arteries with moderate spasm and 12 arteries with severe spasm (14.1%). Two main arteries occlusion was found due to moderate spasm, and a complete occlusion was occurred in three arteries due to severe spasm. The arterial dissection was found in two arteries. Papaverine was used in 31 arteries to deal with the spasm, resultant 29 arteries restored to normal while 2 arteries failed. Conclusion UAS is an important factor that fails UAE, but papaverine is effective to restore the vasospasm.