摘要
目的 探讨经导管子宫动脉栓塞 (TUAE)治疗子宫肌瘤的疗效、安全性及栓后切除标本的病理改变与意义。方法 44例子宫肌瘤患者行经导管子宫动脉注射碘油平阳霉素乳剂 (LPE)加明胶海绵颗粒栓塞治疗 ,其中 7例于栓塞后 1～ 6周行全宫切除或肌瘤剔除术 ,标本送病理检查。另37例随访 1～ 6个月 ,主要观察临床症状改变及肌瘤大小与子宫体积变化。同时 ,通过栓塞后月经观察、卵巢内分泌功能测试、经前诊刮及栓塞后全子宫切除标本病理研究 ,了解栓塞后卵巢功能及正常子宫肌组织的改变。结果 总的症状改善率 91 9% (34 /37) ,其中月经完全恢复正常者占 91 4%(32 /35 ) ,下腹部、腰腿胀痛消失者占 83 3% (2 5 /30 ) ,尿频、尿急等压迫症状消失者占 45 5 7% (5 /11)。栓后 6个月肌瘤体积平均缩小 6 2 4% ,子宫体积平均缩小 5 0 6 %。月经观察无闭经病例发生 ,经前诊刮病理提示子宫内膜呈分泌期改变。卵巢内分泌功能测试栓塞前后变化无明显差异 (P >0 0 5 )。手术标本病理观察 ,碘油仅分布于肌瘤组织 ,栓后 2周肌瘤出现点状坏死 ,3周出现大量片状坏死 ,随着时间延长坏死范围逐渐增大 ,而正常子宫肌层未见坏死。结论 TUAE是一项治疗子宫肌瘤安全、有效的新技术 ;LPE作为栓塞剂 。
Objective To inverstigate the efficiency and safety of transcatheter uterine artery embolization (TUAE) as well as the pathological changes and it′s significance after embolization. Methods 44 cases of uterine fibroids were treated by TUAE using lipiodol pingyangmycin emulsion (LPE) and Gelfoam sponge paeticles. Seven of 44 cases underwent hysterectomy or myomectomy from 1 to 6 weeks after TUAE.The specimens were studied to observe pathological changes of fibroids and myometrium. 37 of 44 patients were followed up for 1 to 6 months to observe the changes of fibroid size and uterine volume. The changes of ovarian function and myometrium after TUAE were found out by observation on mensis, test of ovarian hormone, premenstrual diagnostic curettage and pathology of the resected specimens. Results Total improvement of symptams occurred in 91.9%(34/37), including control of menorrhagia in 91.4%(32/35), disappearance of lumbago and lower abdominal pain in 85 3%(29/34),relief of freguency and urgency of micturition in 50.0%(7/14). Average decrease of fibroid and uterine volume at 6 months after TUAE was 61.3% and 50.6% respectively. No amenorrhea happened. Premenstrual diagnostic curettage showed secretory endomtrium. There was no significant difference in ovarian hormon level befor and after embolization. Pathological study showed that lipiodol was found to deposit in fibroids and was not seen in myometrium. Spotty necrosis 2 weeks occurred in fibroid and extensive patchy necrosis 3 weeks after embolization. The necrotic area became larger with elapse of time postoperative. Necrosis was not seen in myometrium. Conclusion TUAE is a new ,and effective procedure for uterine fibroid and LPE as an embolizing agent is safe without damage on myometrium.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2001年第8期595-599,共5页
Chinese Journal of Radiology
基金
广东省卫生厅高难
高新技术项目 (C2 0 0 0 0 3 1)
关键词
子宫肌瘤
栓塞治疗
并发症
病理学
Uterine fibroids
Embolization, therapeutic
Complication
Pathology
