介入超選擇性子宮動脈栓塞術在治療子宮肌瘤中的應用

潘彥康

[摘要] 目的 探討介入超選擇性子宮動脈栓塞術(TUAE)在治療子宮肌瘤中的應用,提高TUAE對子宮肌瘤所致的不孕癥治療。方法 對12例由臨床、超聲、CT檢查確診為子宮肌瘤,其中黏膜下肌瘤5例,肌壁間肌瘤2例,漿膜下肌瘤5例。單發肌瘤5例,多發肌瘤7例。采用Seldinger技術,經導管雙側子宮動脈注入超液化碘油-平陽霉素乳劑,然后以明膠海綿顆粒栓塞子宮動脈近端。栓塞后3個月、6個月回院復查。同時隨訪12個月以上。結果 插管成功率l00%。所有病例在治療后3個月B超示肌瘤體積平均縮小42%,瘤體內血流信號明顯減少;6個月肌瘤體積平均縮小73%,其中5例肌瘤消失。所有病例月經恢復正常;貧血病例,血紅蛋白升至正常范圍。并發癥發生率8.33%(1/12),經處理后均恢復正常。隨訪18個月后,有3例成功懷孕并各自順產一小孩。結論 TUAE治療子宮肌瘤創傷小,療效顯著;TUAE并發癥少,是可以防治的。TUAE對子宮肌瘤所致的不孕癥有一定療效。

[關鍵詞] 子宮肌瘤;子宮動脈;不孕癥治療;栓塞;治療

[中圖分類號] R737.33[文獻標識碼] A[文章編號] 1004-8650(2009)06-013-03

Application of transcatheter ultra-selective uterine arterial embolization for uterus myoma

PAN Yan - kang

(Department of oncology,the People`s Hospital of Guangxi zhuang Autonomous Region,Nanning 530021,China)

[Abstract] Objective To study the Application of transcatheter ultra-selective uterine artery embolization (TUAE) for treatment of uterus myoma, and the improvement of the treatment with UAE in barrenness suffered from uterus myoma. Methods 12 cases were diagnosed to be uterus myoma by clinic . ultrasound and CT, among them 5 cases were sticky film issues, 2 cases were muscle wall room, 5 cases were the serosa issues . 5 cases were signal uterus myoma, while 7 cases were multiple. All were treated by Seldinger's technique and the transcatheter ultra-selection was used to embolize the proximal end with surpass liquefaction iodine oil- pingyangmycinemulsion ,and then embolizated uterine artery proximal end with gelatin foam rubber .all were rechecked after embolization 3 .6 months. All follow-up at least 12 months. Results the achievement ratio of intubation was l00 %. the average uterus myoma volume diminished 42% or 73% about 3 months and 6 months after the operation reexamining by B-ultrasonography .The bloodstream signal inner tumour body falled off obviously , 5 cases among them the tumours disappeared. All cases menses returned to normal; Anaemia cases , cruorin rised to regular range. Conclusion incidence rate 8.33% (1/12),all can return to normal with healing. Follow-up 18 months ,3 cases to be pregnant successfully and eutocia. Conclusion TUAE in treatment of uterus myoma is small trauma , significant effectivement , hyp -complication and all can be prevented and be cured. TUAE is effect in treatment barrenness suffered from uterus myoma.

[Key words] uterus myoma;uterine artery; treatment barrenness; embolism ; therapy

子宮肌瘤是婦女最常見的盆腔良性腫瘤,又是不孕的原因之一,嚴重影響婦女的身心健康。傳統治療方法有藥物治療和手術切除。介入放射學為子宮肌瘤的治療開辟了新的途徑,自1995年Ravina首次報道子宮動脈栓塞術治療子宮肌瘤[1]以來,已逐步應用于臨床。對自2002年1月-2007年12月期間采用介入超選擇性子宮動脈栓塞術(TUAE)治療子宮肌瘤12例,取得顯著療效,報告如下。

1資料與方法

1.1一般資料

本組12例,由臨床、超聲、CT確診。……