葡聚糖微球栓塞治疗子宫肌瘤疗效的初步观察

Preliminary evaluation of dextran microspheres embolization for treating uterine fibroids

目的 分析葡聚糖微球动脉栓塞治疗子宫肌瘤的相关技术因素、评估该技术治疗 5 0例患者的初步临床疗效。方法 从 1 999年 4月～ 2 0 0 1年 1 0月共对 5 0例子宫肌瘤患者采用葡聚糖微球行超选择性子宫动脉栓塞治疗。患者的临床表现为月经过多、尿频、不孕和下腹坠痛等症状。所有病例均采用右侧股动脉径路、单支猎人头导管双侧子宫动脉插管技术 ,栓塞用葡聚糖微球 (直径 2 2 5～ 4 5 0 μm)和 3～ 5条明胶海绵条块。栓塞后每月行临床和B超随访以观察疗效。结果 超选择插管及栓塞成功率均为 1 0 0 %。栓塞后 92 %的患者疼痛控制良好 ,随访 3个月 4 8例 (96 % )患者临床症状改善 ;2例无效 ,占 4 %。B超随访资料完整的 38例显示 :肌瘤体积随时间推移进行性缩小 ,术后 6个月 ,5例肌瘤消失 ,肌瘤体积平均缩小 6 8%。结论 葡聚糖微球栓塞治疗子宫肌瘤是一种微创性的治疗手段 ,可致使肌瘤实体进行性缩小、临床症状改善 。

Objective To analyze the technical aspects of uterine artery embolization with dextran microspheres and to evaluate the effectiveness of this technique as the primary treatment of uterine fibroids in a series of 50 patients. Methods Thirty eight women(age range, 24 51 years; mean age, 38.2 years) with symptoms caused by uterine fibroids(menorrhagia, mass related symptoms, pelvic pain) were included in this study. We performed embolization with a single Headhunter catheter through the right femoral artery approach with injection of dextran microspheres(225 450μm), and an absorbable gelatin sponge. Follow up study included clinical and sonographic examinations at one month interval for half a year. Results Embolization was performed successfully in all the patients. Post procedural pain control was good in 46(92%) of the patients. In most patients, symptoms were improved within 3 months(96%). Clinical failure of the treatment occurred in only two patients(4%). Progressive reduction in tumor size was revealed during sonographic follow up, and the reduction rate at the sixth month after embolization reached 68% on average. Conclusions Uterine artery embolization with dextran microspheres is a mini invasive method for the treatment of uterine fibroids showing effective in most patients with progressive reduction in size of the masses.