移动医疗(医学百事通)-子宫肌瘤栓塞治疗-500例观察

子宫肌瘤栓塞治疗的进展免费健康咨询（医学百事通）医学百事通网址：栓塞在子宫肌瘤治疗手段中地位的确立(2007)1995年Ravina首先在Lancet上报道了子宫肌瘤栓塞治疗；RavinaJH,HerbreteauD,Ciraru-VigneronNetal.Arterialembolisationtotreatuterinemyomata.Lancet1995;346:671–6722004年美国妇产科学会认可子宫肌瘤栓塞的作用；两个随机对照研究结果最终确立栓塞在子宫肌瘤治疗手段的地位RESTtrialEdwardsRD,MossJG,LumsdenMAetal.Uterine-arteryembolizationversussurgeryforsymptomaticuterinefibroids.NEnglJMed2007;356:360–370.EMMYtrialVolkersNA,HehenkampWJ,BirnieEetal.Uterinearteryembolizationversushysterectomyinthetreatmentofsymptomaticuterinefibroids:2years’outcomefromtherandomizedEMMYtrial.AmJObstetGynecol2007;196(6):519.e1–e11.最终确认栓塞治疗是子宫肌瘤中除子宫切除外的一种安全有效的治疗方法！长期疗效SpiesJB,BrunoJ,Czeyda-PommersheimFetal.Long-termoutcomeofuterinearteryembolizationofleiomyomata.ObstetGynecol2005;106:933–939.87%85%83%79%73%65%70%75%80%85%90%1yr2yr3yr4yr5yr89.5%76.7%76.7%76.7%65.0%70.0%75.0%80.0%85.0%90.0%95.0%1yr3yr4yr5yrKatsumoriT,KasaharaT&AkazawaK.Long-termoutcomesofuterinearteryembolizationusinggelatinspongeparticlesaloneforsymptomaticfibroids.AJRAmJRoentgenol2006;186:848–854.WalkerWJ&Barton-SmithP.Long-termfollowupofuterinearteryembolisation–aneffectivealternativeinthetreatmentoffibroids.BrJObstetGynaecol2006;113:464–468.肌瘤栓塞后5-7年的结果月经量改善压迫症状是否愿意选择和推荐UAE需要进一步治疗75%80%88%16%95.6%81.4%74.4%73.6%0.0%20.0%40.0%60.0%80.0%100.0%120.0%1yr2yr5yr6yr我院500例子宫肌瘤栓塞治疗随访的有效率子宫肌瘤栓塞治疗的有效率长期而稳定！影响疗效的因素影响疗效的因素栓塞不完全子宫动脉主干栓塞不完全仅作单侧子宫动脉栓塞子宫栓塞不完全其他供血动脉（卵巢动脉、变异子宫动脉）肌瘤过大诊断问题（月经量过多或经期延长！）插管技术子宫肌瘤栓塞治疗并发症EdwardsRD,MossJG,LumsdenMAetal.Uterine-arteryembolizationversussurgeryforsymptomaticuterinefibroids.NEnglJMed2007;356:360–370.VolkersNA,HehenkampWJ,BirnieEetal.Uterinearteryembolizationversushysterectomyinthetreatmentofsymptomaticuterinefibroids:2years’outcomefromtherandomizedEMMYtrial.AmJObstetGynecol2007;196(6):519.e1–e11.SiskinGP,Shlansky-GoldbergRD,GoodwinSCetal.Aprospectivemulticentercomparativestudybetweenmyomectomyanduterinearteryembolizationwithpolyvinylalcoholmicrospheres:longtermclinicaloutcomesinpatientswithsymptomaticuterinefibroids.JVascIntervRadiol2006;17:1287–1295.DuttonS,HirstA,McPhersonKetal.AUKmulticentreretrospectivecohortstudycomparinghysterectomyanduterinearteryembolisationforthetreatmentofsymptomaticuterinefibroids(HOPEFULstudy):mainresultsonmedium-termsafetyandefficacy.BrJObstetGynaecol2007;114:1340–1351.WuO,BriggsA,DuttonSetal.Uterinearteryembolisationorhysterectomyforthetreatmentofsymptomaticuterinefibroids:acost-utilityanalysisoftheHOPEFULstudy.BrJObstetGynaecol2007;114:1352–1362.子宫肌瘤栓塞后并发症发生情况病例数轻微并发症严重并发症Razavi(2003)6711%Siskin（2006）7726%EMMY（2006）8864%4.9%REST(2006)10634%12%HOPEFUL(2007)64919%我院子宫肌瘤栓塞术后并发症轻微并发症腹痛27/500（5.4%）发热410/500（82%）阴道出血432/500（86.4%）血尿11/500（2.2%）严重并发症（6/500，2.6%）膀胱误栓1/500（0.2%）短暂性闭经3/500（0.6%）卵巢衰竭3/500（0.6%）栓塞失败1/500（0.2%）栓塞后肌瘤脱落4/500（0.8%）栓塞后盆腔感染1/500（0.2%）术后复发10/500（2%）栓塞对卵巢功能的影响2001年Spies认为栓塞仅对年龄大于45岁的患者有影响，术后闭经发生率为14%；2003年Pron却发现小于40岁的3%患者出现术后闭经；虽然较多的研究通过FSH在栓塞前后的变化来说明栓塞治疗对卵巢较少的影响，但是病例数均较少。这类研究没有考虑到栓塞中常见的卵巢子宫动脉吻合问题，KIM的研究发现若出现该吻合则患者术后会出现FSH的上移。SpiesJB,RothAR,GonsalvesSMetal.Ovarianfunctionafteruterinearteryembolizationforleiomyomata:assessmentwithuseofserumfolliclestimulatinghormoneassay.JVascIntervRadiol2001;12:437–442.PronG,BennettJ,CommonAetal.TheOntarioUterineFibroidEmbolizationTrial.Part2.Uterinefibroidreductionandsymptomreliefafteruterinearteryembolizationforfibroids.FertilSteril2003;79:120–127.SpiesJB,RothAR,GonsalvesSMetal.Ovarianfunctionafteruterinearteryembolizationforleiomyomata:assessmentwithuseofserumfolliclestimulatinghormoneassay.JVascIntervRadiol2001;12:437–442.AhmadA,QadanL,HassanNetal.Uterinearteryembolizationtreatmentofuterinefibroids:effectonovarianfunctioninyoungerwomen.JVascIntervRadiol2002;13:1017–1020.HealeyS,BuzagloK,SetiLetal.Ovarianfunctionafteruterinearteryembolizationandhysterectomy.JAmAssocGynecolLaparosc2004;11:348–352.TropeanoG,DiStasiC,LitwickaKetal.Uterinearteryembolizationforfibroidsdoesnothaveadverseeffectsonovarianreserveinregularlycyclingwomenyoungerthan40years.FertilSteril2004;81:1055–1061.HovsepianDM,RattsVS,RodriguezMetal.Aprospectivecomparisonoftheimpactofuterinearteryembolization,myomectomy,andhysterectomyonovarianfunction.JVascIntervRadiol2006;17:1111–1115.KimHS,TsaiJ,LeeJMetal.Effectsofutero-ovariananastomosesonbasalfollicle-stimulatinghormonelevelchangeafteruterinearteryembolizationwithtris-acrylgelatinmicrospheres.JVascIntervRadiol2006;17:965–971.KimHS,ThonseVR,JudsonKetal.Utero-ovariananastomosis:histopathologiccorrelationafteruterinearteryembolizationwithorwithoutovarianarteryembolization.JVascIntervRadiol2007;18:31–39.如何处理子宫动脉造影中卵巢支显影的病例？我院在子宫肌瘤栓塞子宫动脉造影中其双侧卵巢支显影处理的临床研究子宫动脉造影中卵巢支显影情况双侧卵巢支显影单侧卵巢支显影无卵巢支显影53（41.4%，53/128）31（24.2%，31/128）44（34.3%，44/128）子宫肌瘤栓塞患者子宫动脉造影其双侧卵巢支显影非显影组显影明胶海绵组显影组非显影聚乙烯醇组非显影明胶海绵组三组病例临床症状改善情况显影组非显影聚乙烯醇组非显影明胶海绵组栓塞后月经量恢复正常20/2020/2117/19栓塞前压迫症状消失1/21/13/3总体症状改善21/22，95.4%21/22，95.4%20/22，90.9%χ2值0.5323*P0.05*三组进行组组间χ2检验，统计学未见组组间疗效有差异性。三组病例栓塞前后FSH的变化显影组非显影聚乙烯醇组非显影明胶海绵组栓塞前FSH(IU/L)11.10±1.5013.07±1.1811.45±1.74栓塞后FSH(