Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus.It is the most common gynecological disorder,affecting up to 80%of women of reproductive age.Uterine fibroids can cause various ...Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus.It is the most common gynecological disorder,affecting up to 80%of women of reproductive age.Uterine fibroids can cause various symptoms such as abnormal uterine bleeding,pelvic pain,infertility,and pregnancy complications.The treatment options for uterine fibroids include medical therapy,surgical intervention,and minimally invasive techniques.AIM To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization(UAE).METHODS This prospective cohort study enrolled 87 women with symptomatic uterine fibroids who underwent UAE,and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments.The two groups were matched for age,body mass index,parity,and baseline characteristics of uterine fibroids.The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),and anti-Müllerian hormone(AMH),as well as ovarian reserve tests,such as antral follicle count(AFC)and ovarian volume(OV).The secondary outcome was fertility that was evaluated based on the menstrual cycle,ovulation,conception,pregnancy,and delivery.The participants were followed-up for 36 months and assessed at 1,3,6,12,24,and 36 months after treatment.RESULTS The study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women,resolving within a week.No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones(FSH,LH,E2,AMH)and ovarian reserve indicators(AFC,OV)at any point up to 36 months post-treatment.Additionally,there were no significant differences in conception,pregnancy,or delivery rates,with the average time to conception and gestational age at delivery being similar between the two groups.Birth weights were also comparable.Finally,there was no significant correlation between ovarian function,fertility indicators,and the type or amount of embolic agent used or the change in fibroids posttreatment.CONCLUSION UAE resulted in significantly positive pregnancy outcomes,no adverse events post-treatment,and is a safe and effective treatment for uterine fibroids that preserves ovarian function and fertility.展开更多
Objective： To evaluate the outcomes of selective uterine artery embolization （SUAE） in treatment of symptomatic uterine fibroids using Color Doppler ultrasonography （CDUS）. Methods： As the procedure SUAE for fib...Objective： To evaluate the outcomes of selective uterine artery embolization （SUAE） in treatment of symptomatic uterine fibroids using Color Doppler ultrasonography （CDUS）. Methods： As the procedure SUAE for fibroids, prospective data of the initial 65 consecutive women treated from March 2007 to September 2009 were collected. The follow-up period from 1 week to 30 months, using questionnaires, we investigated the fibroid-related physical and psychological symptoms, and the cumulative rates of symptom control, gynecologic interventions, and complications. The volumes of uterine and uterine fibroids were calculated by CDUS pre- and post-SUAE for 6 months. And we tested the levels of internal hormone including FSH, LH and E2 before and after SUAE for 3, 6 months. Results： SUAE was performed successfully in all patients. There was no peri-operative morbidity in all procedures. Compared with pre-SUAE volumes of uterine [（322± 12） cm^3] and uterine fibroids [（125±46） cm^3], their volumes in post-SUAE were （144±72） cm^3 and （51 a：l 1） cm^3 （P〈0.01）, and reduction rate was 58% and 61%, respectively. At 3, 6 months after SUAE, levels of FSH, LH, and E2 were not decreased than that of in pre-SUAE （P〉0.05）. After SUAE for 24 months, the fibroids related physical and psychological symptoms such as bleeding, pain and quality of life were significantly improved （P〈0.01）. 90.8% （59/65） women had resolution of symptoms and no significant post-procedural symptoms. Parts of patients discharge necrotic fibroids. 86% （34/40） complications were minor, requiring no therapy. 9.2% （6/65） had significant post-procedural symptoms, requiring therapy in hospital or out-patient department. Conclusion： SUAE contributes to a long-term significant improvement of all investigated uterine fibroid-related symptoms and markedly improves women＇s health-related quality of life. SUAE that no impair on changes of internal hormone, under suitable conditions, represents an attractive alternative to hysterectomy for the treatment of symptomatic fibroids and is a minimally invasive, new method of good clinical prognosis. CDUS is an effective to investigate the outcome of SUAE.展开更多
OBJECTIVE To investigate the effects of percutaneous cryoablation on uterine fibroids using computed tomographic （CT） guidance after uterine artery embolization.METHODS Twelve patients who failed to respond to uteri...OBJECTIVE To investigate the effects of percutaneous cryoablation on uterine fibroids using computed tomographic （CT） guidance after uterine artery embolization.METHODS Twelve patients who failed to respond to uterine artery em- bolization were treated using percutaneous cryoablation. All patients had undergone previous uterine artery embolization an average of 1.2 years （0.7-1.6 years） ago. Two cases had abnormal bleeding, and the other 10 suffered from pressure and/or pelvic pain. Myoma diameters were 4 cm to 16.5 cm. By using CT guidance, 2.0, 2.4, 3.0 or 3.8 mm cryoprobes were placed into the fibroid, and two 15-20 rain freezing processes were performed. Hemostasis was achieved only by pressing the incisions for several minutes. MR-imaging was performed before the procedure to measure the size and number of fibroid tumors, and follow- up MR-imaging determined the reduction of the lesions.RESULTS All patients were discharged within 48 h of treatment. Almost no hemorrhage was found in all of the cases. No bladder or bowel injury or significant postsurgery pain was reported. Ice spheres were readily visualized at CT. Beam-hardening artifact from the metal probes was present, but did not interfere with the procedure. Myomas regressed up to 76.3% after 12 months of treatment, and the primary symptoms improved in all treated women.CONCLUSION CT-monitored percutaneous cryoablation is an effective and minimally invasive therapy for symptom relief and fibroid shrinkage after the failure of uterine artery embolization.展开更多
Background: Submucosal fibroids account for approximately 15 - 20 percent of total fibroids. Rarely, they prolapse. Common size is 2 - 6 cm, because larger fibroids are unlikely to fit through the cervix. Larger fibro...Background: Submucosal fibroids account for approximately 15 - 20 percent of total fibroids. Rarely, they prolapse. Common size is 2 - 6 cm, because larger fibroids are unlikely to fit through the cervix. Larger fibroids are associated with significant bleeding and pose a surgical challenge. Case Presentation: We present a 38-year-old woman nulliparous with an intravaginal pedunculated fibroid, 12 cm in diameter. She presented with metrorrhagia and an intense malodorous vaginal discharge, irresponsive to oral therapy. The patient had a history of resectoscopic fibroid enucleation, 7 months earlier, followed by insertion of an (intra-uterine device) IUD. There was no uterine prolapse. Management involved bilateral uterine artery embolization, followed by hysteroscopic excision with rigid resectoscope. The fibroid was “delivered” transvaginally intact. The uterus was preserved. The IUD was partly buried within the mass. Blood loss was negligible. Patient recovery was quick and uneventful. At 6-months follow up, pelvic anatomy has been restored. Conclusion: Large pedunculated fibroids are very rare. Embolization of uterine arteries has proven a valuable tool in challenging gynecologic operations. In our case, not only it prevented massive bleeding during excision, but also allowed a fertility-sparing minimally invasive management.展开更多
Some patients who undergo Uterine Artery Embolization (UAE) for symptomatic leiomyomata have collateral ovarian artery supply to the uterus. This typically occurs when the ipsilateral uterine artery is small or absent...Some patients who undergo Uterine Artery Embolization (UAE) for symptomatic leiomyomata have collateral ovarian artery supply to the uterus. This typically occurs when the ipsilateral uterine artery is small or absent, and the ovarian artery supply to the uterus can lead to UAE failure. The authors present a case of a woman treated with UAE who had an atretic right uterine artery and an enlarged right ovarian artery supplying the fibroids. The ovarian artery arose from the proximal internal iliac artery. This rare variant vessel was embolized leading to eradication of the patient’s symptoms. The success of this case highlights the need to evaluate for possible variant ovarian artery supply and to embolize these vessels in an attempt to prevent UAE failure.展开更多
基金Supported by Key Project of Medical Science Research in Hebei Province,China,No.20160005.
文摘Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus.It is the most common gynecological disorder,affecting up to 80%of women of reproductive age.Uterine fibroids can cause various symptoms such as abnormal uterine bleeding,pelvic pain,infertility,and pregnancy complications.The treatment options for uterine fibroids include medical therapy,surgical intervention,and minimally invasive techniques.AIM To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization(UAE).METHODS This prospective cohort study enrolled 87 women with symptomatic uterine fibroids who underwent UAE,and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments.The two groups were matched for age,body mass index,parity,and baseline characteristics of uterine fibroids.The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),and anti-Müllerian hormone(AMH),as well as ovarian reserve tests,such as antral follicle count(AFC)and ovarian volume(OV).The secondary outcome was fertility that was evaluated based on the menstrual cycle,ovulation,conception,pregnancy,and delivery.The participants were followed-up for 36 months and assessed at 1,3,6,12,24,and 36 months after treatment.RESULTS The study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women,resolving within a week.No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones(FSH,LH,E2,AMH)and ovarian reserve indicators(AFC,OV)at any point up to 36 months post-treatment.Additionally,there were no significant differences in conception,pregnancy,or delivery rates,with the average time to conception and gestational age at delivery being similar between the two groups.Birth weights were also comparable.Finally,there was no significant correlation between ovarian function,fertility indicators,and the type or amount of embolic agent used or the change in fibroids posttreatment.CONCLUSION UAE resulted in significantly positive pregnancy outcomes,no adverse events post-treatment,and is a safe and effective treatment for uterine fibroids that preserves ovarian function and fertility.
基金Supported by the Science and Technology Foundation of Shaanxi (2005K09-G6)
文摘Objective： To evaluate the outcomes of selective uterine artery embolization （SUAE） in treatment of symptomatic uterine fibroids using Color Doppler ultrasonography （CDUS）. Methods： As the procedure SUAE for fibroids, prospective data of the initial 65 consecutive women treated from March 2007 to September 2009 were collected. The follow-up period from 1 week to 30 months, using questionnaires, we investigated the fibroid-related physical and psychological symptoms, and the cumulative rates of symptom control, gynecologic interventions, and complications. The volumes of uterine and uterine fibroids were calculated by CDUS pre- and post-SUAE for 6 months. And we tested the levels of internal hormone including FSH, LH and E2 before and after SUAE for 3, 6 months. Results： SUAE was performed successfully in all patients. There was no peri-operative morbidity in all procedures. Compared with pre-SUAE volumes of uterine [（322± 12） cm^3] and uterine fibroids [（125±46） cm^3], their volumes in post-SUAE were （144±72） cm^3 and （51 a：l 1） cm^3 （P〈0.01）, and reduction rate was 58% and 61%, respectively. At 3, 6 months after SUAE, levels of FSH, LH, and E2 were not decreased than that of in pre-SUAE （P〉0.05）. After SUAE for 24 months, the fibroids related physical and psychological symptoms such as bleeding, pain and quality of life were significantly improved （P〈0.01）. 90.8% （59/65） women had resolution of symptoms and no significant post-procedural symptoms. Parts of patients discharge necrotic fibroids. 86% （34/40） complications were minor, requiring no therapy. 9.2% （6/65） had significant post-procedural symptoms, requiring therapy in hospital or out-patient department. Conclusion： SUAE contributes to a long-term significant improvement of all investigated uterine fibroid-related symptoms and markedly improves women＇s health-related quality of life. SUAE that no impair on changes of internal hormone, under suitable conditions, represents an attractive alternative to hysterectomy for the treatment of symptomatic fibroids and is a minimally invasive, new method of good clinical prognosis. CDUS is an effective to investigate the outcome of SUAE.
文摘OBJECTIVE To investigate the effects of percutaneous cryoablation on uterine fibroids using computed tomographic （CT） guidance after uterine artery embolization.METHODS Twelve patients who failed to respond to uterine artery em- bolization were treated using percutaneous cryoablation. All patients had undergone previous uterine artery embolization an average of 1.2 years （0.7-1.6 years） ago. Two cases had abnormal bleeding, and the other 10 suffered from pressure and/or pelvic pain. Myoma diameters were 4 cm to 16.5 cm. By using CT guidance, 2.0, 2.4, 3.0 or 3.8 mm cryoprobes were placed into the fibroid, and two 15-20 rain freezing processes were performed. Hemostasis was achieved only by pressing the incisions for several minutes. MR-imaging was performed before the procedure to measure the size and number of fibroid tumors, and follow- up MR-imaging determined the reduction of the lesions.RESULTS All patients were discharged within 48 h of treatment. Almost no hemorrhage was found in all of the cases. No bladder or bowel injury or significant postsurgery pain was reported. Ice spheres were readily visualized at CT. Beam-hardening artifact from the metal probes was present, but did not interfere with the procedure. Myomas regressed up to 76.3% after 12 months of treatment, and the primary symptoms improved in all treated women.CONCLUSION CT-monitored percutaneous cryoablation is an effective and minimally invasive therapy for symptom relief and fibroid shrinkage after the failure of uterine artery embolization.
文摘Background: Submucosal fibroids account for approximately 15 - 20 percent of total fibroids. Rarely, they prolapse. Common size is 2 - 6 cm, because larger fibroids are unlikely to fit through the cervix. Larger fibroids are associated with significant bleeding and pose a surgical challenge. Case Presentation: We present a 38-year-old woman nulliparous with an intravaginal pedunculated fibroid, 12 cm in diameter. She presented with metrorrhagia and an intense malodorous vaginal discharge, irresponsive to oral therapy. The patient had a history of resectoscopic fibroid enucleation, 7 months earlier, followed by insertion of an (intra-uterine device) IUD. There was no uterine prolapse. Management involved bilateral uterine artery embolization, followed by hysteroscopic excision with rigid resectoscope. The fibroid was “delivered” transvaginally intact. The uterus was preserved. The IUD was partly buried within the mass. Blood loss was negligible. Patient recovery was quick and uneventful. At 6-months follow up, pelvic anatomy has been restored. Conclusion: Large pedunculated fibroids are very rare. Embolization of uterine arteries has proven a valuable tool in challenging gynecologic operations. In our case, not only it prevented massive bleeding during excision, but also allowed a fertility-sparing minimally invasive management.
文摘Some patients who undergo Uterine Artery Embolization (UAE) for symptomatic leiomyomata have collateral ovarian artery supply to the uterus. This typically occurs when the ipsilateral uterine artery is small or absent, and the ovarian artery supply to the uterus can lead to UAE failure. The authors present a case of a woman treated with UAE who had an atretic right uterine artery and an enlarged right ovarian artery supplying the fibroids. The ovarian artery arose from the proximal internal iliac artery. This rare variant vessel was embolized leading to eradication of the patient’s symptoms. The success of this case highlights the need to evaluate for possible variant ovarian artery supply and to embolize these vessels in an attempt to prevent UAE failure.
