子宫动脉栓塞治疗症状性子宫肌瘤的临床研究
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摘要
目的：探讨子宫动脉栓塞术(UAE)治疗症状性子宫肌瘤的临床治疗效果。
材料与方法：选择经B超和妇科检查确诊的50例症状性子宫肌瘤患者,采用Seldinger技术,经皮股动脉穿刺行双侧子宫动脉插管栓塞治疗。栓塞剂选用PVA颗粒联合明胶海绵颗粒或碘油平阳霉素乳剂联合明胶海绵颗粒。测量患者术前肌瘤体积大小、子宫体积大小、卵巢相关激素水平、月经量及血红蛋白的含量,对比术前、术后患者临床症状的改善情况,随访术后3、6、12月肌瘤体积大小、子宫体积大小、卵巢相关激素水平变化及并发症的情况。
结果：50例症状性子宫肌瘤患者,平均年龄42.6±3.7岁。手术插管、造影成功率100%,47例子宫肌瘤为双侧子宫动脉供血,3例为单侧子宫动脉供血,栓塞治疗后子宫肌瘤血供被完全阻断,临床症状改善明显,月经量减少、月经周期恢复正常、贫血改善(P<0.05),痛经、腰背部坠痛、尿频、便秘症状消失。术前子宫肌瘤平均体积为61.0±17.2cm3、子宫平均体积为340.4±31.5 cm3,术后3、6、12月随访显示,子宫体积缩小率为：38.2%、46.7%、49.7%、子宫肌瘤体积缩小率为：32.1%、65.9%、74.8%，均呈进行性减小,与术前比较有统计学显著性差异(P<0.05),术后12个月总有效率为：94%。术后1周患者均出现栓塞后综合症,包括疼痛(40/50)、发热(38/50)、胃肠道反应(24/50)、阴道不规则出血(43/50),对症处理后症状缓解或消失,除1例发生闭经外,其他无子宫内膜炎、子宫化脓症等严重并发症发生。关于卵巢内分泌功能相关激素水平的随访情况,雌二醇(E2)、促卵泡素(FSH)、黄体生成素(LH)水平术前与术后3、6、12月比较无统计学显著性差异(乃0.05)
结论子宫动脉栓塞治疗症状性子宫肌瘤可明显改善患者临床症状,无严重并发症,子宫和子宫肌瘤体积术后均明显缩小。它能保留子宫和卵巢的正常生理功能,避免开腹手术所造成的生理和心理的创伤。具有高效、微创、并发症少等优点,是治疗子宫肌瘤的一种新的途径。
Objective:To investigate the therapeutic effect of uterine artery embolization (UAE) in treatment of symptomatic hysteromyoma.
Materials and Methods:Under the guidance of X-ray, the selective uterine artery embolization (UAE) were done in 50 Patients with symptomatic hysteromyoma who were diagnosed by gynaecologist and measured by sonography. Embolizing agents include Polythene vinyl alcohol(PVA), Pingyangmycin, super lipiodol emulsion and gelatin sponge particles. To measure the patients' hysteromyoma and uterine volume, the level of hormone about ovary(E2,FSH,LH), the amount of menses and protoferriheme before UAE, to compare the change of the patients' clinical symptoms before and after UAE.50 patients were followed up for 3,6,12 months about their hysteromyoma and uterine volume, the level of hormone about ovary(E2,FSH,LH) and complication after UAE.
Results:50 patients with symptomatic hysteromyoma were performed with UAE,the average 42.6±3.7 years. The success rate of uterine artery angiography was 100%(50/50). Angiography revealed a rich blood supply of 47 cases patents' uterine fibroids by bilateral uterine artery,3 cases patents'uterine fibroids were supplied by single uterine artery. Bilateral uterine arteries were embolized after UAE, the clinical symptoms were obviously improved, and patients returned to normal menstrual cycle, anaemia were improved(P<0.05).The average volume of hysteromyoma before UAE is 61.0±17.2cm3, the average volume of womb before UAE is 340.4±31.5 cm3. After UAE 50 patients were followed up for 3,6,12 months, the remission rate of uterine volume was 38.2%、46.7%、49.7%, the remission rate of hysteromyoma was 32.1%、65.9%、74.8%. There is a statistical significant(P<0.05) comparing with pro-UAE. The total effective rate was 94% 12 months after UAE. There was post embolization comprehensive symptom including pain(40/50), fever(38/50), gastrointestinal symptom (24/50), vagino bleeding (43/50) 1 week after UAE, the symptom disappeared after being treated. Except that 1 case was menostasis, there were no serious complications such as hysteritis and pus from infected hysteromyoma. To compare the level of hormone about ovary(E2,FSH,LH) before UAE and 3,6,12 months after UAE, there was no statistical significant difference(P>0.05).
Conclusion:The clinical symptoms of Symptomatic hysteromyoma were obviously improved by UAE, no serious complications occurred,50 patients' hysteromyoma and uterine volume were shrink. It can protect the normal function of womb and hormone, avoiding injury from the traditional surgeon. UAE was an effective way and minimally invasive treatment for symptomatic hysteromyoma with few complications. UAE is a new treatment for symptomatic hysteromyoma.
材料与方法：选择经B超和妇科检查确诊的50例症状性子宫肌瘤患者,采用Seldinger技术,经皮股动脉穿刺行双侧子宫动脉插管栓塞治疗。栓塞剂选用PVA颗粒联合明胶海绵颗粒或碘油平阳霉素乳剂联合明胶海绵颗粒。测量患者术前肌瘤体积大小、子宫体积大小、卵巢相关激素水平、月经量及血红蛋白的含量,对比术前、术后患者临床症状的改善情况,随访术后3、6、12月肌瘤体积大小、子宫体积大小、卵巢相关激素水平变化及并发症的情况。
结果：50例症状性子宫肌瘤患者,平均年龄42.6±3.7岁。手术插管、造影成功率100%,47例子宫肌瘤为双侧子宫动脉供血,3例为单侧子宫动脉供血,栓塞治疗后子宫肌瘤血供被完全阻断,临床症状改善明显,月经量减少、月经周期恢复正常、贫血改善(P<0.05),痛经、腰背部坠痛、尿频、便秘症状消失。术前子宫肌瘤平均体积为61.0±17.2cm3、子宫平均体积为340.4±31.5 cm3,术后3、6、12月随访显示,子宫体积缩小率为：38.2%、46.7%、49.7%、子宫肌瘤体积缩小率为：32.1%、65.9%、74.8%，均呈进行性减小,与术前比较有统计学显著性差异(P<0.05),术后12个月总有效率为：94%。术后1周患者均出现栓塞后综合症,包括疼痛(40/50)、发热(38/50)、胃肠道反应(24/50)、阴道不规则出血(43/50),对症处理后症状缓解或消失,除1例发生闭经外,其他无子宫内膜炎、子宫化脓症等严重并发症发生。关于卵巢内分泌功能相关激素水平的随访情况,雌二醇(E2)、促卵泡素(FSH)、黄体生成素(LH)水平术前与术后3、6、12月比较无统计学显著性差异(乃0.05)
结论子宫动脉栓塞治疗症状性子宫肌瘤可明显改善患者临床症状,无严重并发症,子宫和子宫肌瘤体积术后均明显缩小。它能保留子宫和卵巢的正常生理功能,避免开腹手术所造成的生理和心理的创伤。具有高效、微创、并发症少等优点,是治疗子宫肌瘤的一种新的途径。
Objective:To investigate the therapeutic effect of uterine artery embolization (UAE) in treatment of symptomatic hysteromyoma.
Materials and Methods:Under the guidance of X-ray, the selective uterine artery embolization (UAE) were done in 50 Patients with symptomatic hysteromyoma who were diagnosed by gynaecologist and measured by sonography. Embolizing agents include Polythene vinyl alcohol(PVA), Pingyangmycin, super lipiodol emulsion and gelatin sponge particles. To measure the patients' hysteromyoma and uterine volume, the level of hormone about ovary(E2,FSH,LH), the amount of menses and protoferriheme before UAE, to compare the change of the patients' clinical symptoms before and after UAE.50 patients were followed up for 3,6,12 months about their hysteromyoma and uterine volume, the level of hormone about ovary(E2,FSH,LH) and complication after UAE.
Results:50 patients with symptomatic hysteromyoma were performed with UAE,the average 42.6±3.7 years. The success rate of uterine artery angiography was 100%(50/50). Angiography revealed a rich blood supply of 47 cases patents' uterine fibroids by bilateral uterine artery,3 cases patents'uterine fibroids were supplied by single uterine artery. Bilateral uterine arteries were embolized after UAE, the clinical symptoms were obviously improved, and patients returned to normal menstrual cycle, anaemia were improved(P<0.05).The average volume of hysteromyoma before UAE is 61.0±17.2cm3, the average volume of womb before UAE is 340.4±31.5 cm3. After UAE 50 patients were followed up for 3,6,12 months, the remission rate of uterine volume was 38.2%、46.7%、49.7%, the remission rate of hysteromyoma was 32.1%、65.9%、74.8%. There is a statistical significant(P<0.05) comparing with pro-UAE. The total effective rate was 94% 12 months after UAE. There was post embolization comprehensive symptom including pain(40/50), fever(38/50), gastrointestinal symptom (24/50), vagino bleeding (43/50) 1 week after UAE, the symptom disappeared after being treated. Except that 1 case was menostasis, there were no serious complications such as hysteritis and pus from infected hysteromyoma. To compare the level of hormone about ovary(E2,FSH,LH) before UAE and 3,6,12 months after UAE, there was no statistical significant difference(P>0.05).
Conclusion:The clinical symptoms of Symptomatic hysteromyoma were obviously improved by UAE, no serious complications occurred,50 patients' hysteromyoma and uterine volume were shrink. It can protect the normal function of womb and hormone, avoiding injury from the traditional surgeon. UAE was an effective way and minimally invasive treatment for symptomatic hysteromyoma with few complications. UAE is a new treatment for symptomatic hysteromyoma.
引文
[1]Reidy JF, Bradley EA. Uterine artery embolization to treat uterine fibroids [J]. Cardiovasc Intervent Radiol,1998,21(7):357-359.
[2]Ravina JH, Herbreteau D, Ciraru-Vigneron N, et al. Arterial embolization to treatment uterin emyomata[J]. Lancet,1995,346(s976):671-672.
[3]陈春林.子宫动脉栓塞治疗子宫肌瘤的适应证及临床疗效[J].实用妇产杂志,2007,23(12)：714-716.
[4]Ravina JH, Herbreteau D, Ciraru-Vigneron N, et al. Arterial embolization to treatment uterin emyomata[J]. Lancet,1995,346(s976):671-672.
[5]Hutchins FL, Jr Oorthington Kitsch R, Berrowitz RP. Selective utmirmartery embolization as primary treatment for symptomatic Leiomyomatauteri[J]. J Am Assoc Gyneeol Laparme,1999,6(3):279-284.
[6]刘晋波,王文新,高平,等.子宫动脉栓塞术治疗子宫肌瘤的技术应用[J].中国医学影像技术,2003,19(1)：95-97.
[7]陈晓明,杜娟,左约维,等。子宫肌瘤导管栓塞治疗的临床与病理研究。中华放射杂志,2001,35(8)：595-599。
[8]Gray P, Lisle A, et al. Pathologic findings in a uterine leiomyoma after bilateral uterine artery embolization. JVIR,1999,10:891-4.
[9]Nicholson, Pelage, et al. Fibroid calcification after uterine artery embolization: ultrasonographic appearance and pathology. JVIR,2001, Apr,12(4):448-6.
[10]Worthington-Kirsch RL, Popky GL Hutchins FL. Uterine Arterial Embolization for the Management of Leiomyoimas:Quality-of Life as Sessment and Clinical"Response[J]. Radiology,1998,208(3):625-629.
[11]Pelage JP, le Dref O, Soyer P, et al. Fibroid Related Menorrhagia:Treatment with Superselective Embolization of the U terine Arteries and Midterm Follow up[J]. Radiology,2000,215(2):428-431
[12]Bradley E A, Reidy JF, Forman RG, et al. Transcatheter Uterine Artery Embolization to Treat Large Uterine Fibroid[J]. Br Obstet Gynaecd,1998。105(2): 235-240.
[13]Ravina JH。 AymantA, Ciraru Vigneon N, etal. Arterial embolization ofu. terlne myoma:results apropos of 286cases[J]. J Gynecol Obstet Biol Reprod(Parise), 2000,29(3):272-275.
[14]谭伟,柯要军。姜陵。等.子宫动脉栓塞治疗子宫肌瘤的中远期随访研究[J].中华放射学杂志,2003。37(7)：648-653.
[15]Bnunereau L, Herbreteau D, Gallas S, et al. Uterine artery embolization intheprimary treatment of uterine ldomyo-mas[J]. AIR Am J Roentgenol,2000, 175(5):1276-1272.
[16]Katsumori,Nakajima, et al. uterine artely embolization using gelatin sponge particles alone for age, et al. Fibroid calcification after uterine artery embolization: ultrasonographic y,2000,215(2):428-431
[17]Spies, Benenati, et al. Initial experience with use of tris-acryl gelatin microspheres for, uterine artery embolization for leiomyoma. J-Vasc-Interv-Radiol,2001,Sep,12(9):1059-63.
[18]李茂全,张庆,夏文龙,等。PVA与丝线段栓塞子宫肌瘤的对照研究。中华实用医学,2002,4(13)：36-38。
[19]Pelage, polyvinyl alcohol particles size for uterine artery embolization. Radiology,2001,Feb,218(2):605-6.
[20]雷蔚华。陈春林,刘萍,等.患者自控镇痛在动脉栓塞治疗子宫肌瘤围手术期中的应用[J].现代妇产科进展。2001,10(2)：102-104.
[21]陈俊,吴大哲,刘裕恒.不同镇痛方法在子宫肌瘤介人治疗中的效果分析[J].放射学实践。2003,18(10)：787-788.
[22]崔竹梅。子宫动脉栓塞治疗症状性子宫肌瘤。世界医学杂志,2000,4(6)：22-27.
[23]Goodwin SC,Vedantham S,Mulucsa B,et al. Uterine artery em2bolization for uterine fibroids:Result of a pilot study [J]. JVIR,1997,8 (3):517-526.
[24]Payne J F,Haney AF. Serious complications of uterine artery em2bolization for conservative treatment of fibroids [J]. Fertil Steril,2003,79 (1):128-131.
[25]Ravina J H,Bouret JM,Ciraru2Vigneron N,et al. Recourse to particular artrtial embolization in the treatmentof some uterine [J].Bull Acad Natl Med,1997,181:233-243.
[26]Bradley EA, Reidy J F, Forman RG, et al. Trancather uterineartery embolisation to treat large uterine fibroids[J].Br J ObstetGnaecol,1998,105:235-240.
[27]Mclucas, Adler, et al。Uterine fibroid embolization:nonsurgical treatment for symptomatic fibroids。J-Am-Coll-Surg,2001 Jan;192(1):95-105.
[28]谭伟,柯要军。子宫动脉栓塞治疗子宫肌瘤的临床应用研究。中国医学计算机成像杂志,2000,6(2)：124-128。
[29]Watson, Walker, etd. Uterine artery embolization for the treatment of symptomatic fibroid in 114 women:reduction in size of the fibroids and women's views of the treatment. BJOG,2002 Feb,109(2):129-135.
[30]Jean-Pierre P, Olivier LD, Philippe S, et al, Fibroid-related menorrhagia:treatment with superselective embolization of the arteries and midterm follow up, Radiology.2000,215:428-431.
[31]Worthington-Kirsch RL, Popky GL, Hutchins FL, Uterine arterial emlolization for the management of leiomyomas:quality-of-life and clinical response, Radiology,1998,208:625-629.
[32]Broder MS, Goodwin S, Chen G, et al. Comparison of Long-term Outcomes of Myomectomy and Uterine Artery Embolization[J]. Obstet Gynecol,2002,100(5Pt 1):864-868. 现的子宫破裂及胎盘功能情况知之甚少。由于上述原因,对于年龄较小、尚未生育和希望保留生育能力的患者来说,采用UAE应慎重考虑。为此,Pelage提出了栓塞程度的标准：1、与肌瘤有关的肿瘤血管消失；2、子宫动脉远端学流变慢；3、子宫动脉主干、包括支配卵巢和阴道的血管保留。
综上所诉,UAE作为治疗症状性子宫肌瘤的一个重要手段,虽然取得了较好的效果,但尚有许多工作有待研究。1、它的远期疗效如何,目前尚缺乏大宗病例报道；2、如何尽量预防及有效治疗其并发症,如对卵巢的功能及生育能力的影响；3、明确各种子宫肌瘤的血供特点,从而合理选择适应症,制定规范化的介入治疗方案等,都是UAE面临的研究课题。
[1]Reidy JF, Bradley EA. Uterine artery embolization to treat uterine fibroids [J]. Cardiovasc Intervent Radiol,1998,21(7):357-359.
[2]Ravina JH, Herbreteau D, Ciraru-Vigneron N, et al. Arterial embolization to treatment uterin emyomata[J]. Lancet,1995,346(s976):671-672.
[3]Hutchins FL, Jr Oorthington Kitsch R, Berrowitz RP. Selective utmirmartery embolization as primary treatment for symptomatic Leiomyomatauteri[J]. J Am Assoc Gyneeol Laparme,1999,6(3):279-284.
[4]刘晋波,王文新,高平,等.子宫动脉栓塞术治疗子宫肌瘤的技术应用[J].中国医学影像技术,2003,19(1)：95-97.
[5]Pelage, Laurent, et al. Arterial blood supply to the uterus in nonpregnant sheep:A pertinent model for clinical ptactice Inter-Radiol,2001, Dec,36(12):721-5.
[6]Gray P, Lisle A, et al. Pathologic findings in a uterine leiomyoma after bilateral uterine artery embolization. JVIR,1999,10:891-4.
[7]Nicholson, Pelage, et al. Fibroid calcification after uterine artery embolization: ultrasonographic appearance and pathology. JVIR,2001, Apr,12(4):448-6.
[8]Worthington-Kirsch RL, Popky GL Hutchins FL. Uterine Arterial Embolization for the Management of Leiomyoimas:Quality-of Life as Sessment and Clinical"Response[J]. Radiology,1998,208(3):625-629.
[9]Pelage JP, le Dref O, Soyer P, et al. Fibroid Related Menorrhagia:Treatment with Superselective Embolization of the U terine Arteries and Midterm Follow up[J]. Radiology,2000,215(2):428-431
[10]Bradley EA, Reidy JF, Forman RG, et al. Transcatheter Uterine Artery Embolization to Treat Large Uterine Fibroid[J]. Br Obstet Gynaecd,1998。105(2): 235-240.
[11]Mclucas, Adler, et al。 Uterine fibroid embolization:nonsurgical treatment for symptomatic fibroids。 J-Am-Coll-Surg,2001 Jan; 192(1):95-105.
[12]谭伟,柯要军。子宫动脉栓塞治疗子宫肌瘤的临床应用研究。中国医学计算机成像杂志,2000,6(2)：124-128。
[13]Watson, Walker, etd. Uterine artery embolization for the treatment of symptomatic fibroid in 114 women:reduction in size of the fibroids and women's views of the treatment. BJOQ2002 Feb,109(2):129-135.
[14]Broder MS, Goodwin S, Chen G, et al. Comparison of Long-term Outcomes of Myomectomy and Uterine Artery Embolization[J]. Obstet Gynecol,2002,100(5Pt 1):864-868.
[15]谭伟,柯要军。姜陵。等.子宫动脉栓塞治疗子宫肌瘤的中远期随访研究[J].中华放射学杂志,2003。37(7)：648-653.
[16]雷蔚华。陈春林,刘萍,等.患者自控镇痛在动脉栓塞治疗子宫肌瘤围手术期中的应用[J].现代妇产科进展。2001,10(2)：102-104.
[17]陈俊，吴大哲,刘裕恒.不同镇痛方法在子宫肌瘤介人治疗中的效果分析[J].放射学实践。2003,18(10)：787-788.
[18]崔竹梅,子宫动脉栓塞治疗症状性子宫肌瘤。世界医学杂志,2000,4(6)：22-27.
[19]Pollard, Goldberg, et al. Prolapsed cervical myoma after uterine artery embolization A case report. J-Reprod-Med,2001, May,46(5):499-500.
[20]Bradley EA, Reidy JF, Forman RG, et al. Transcatheter Uterine Artery Embolization to Treat Large Uterine Fibroid[J]. Br Obstet Gynaecd,1998 。105(2) symptomatic uterine fibroids:midterm results. AJR-Am-J-Roentgenol,2002:Jan,178(1):135-9.
[21]Hameed, Heller, et al. Squamous metaplasia of endometrium after uterine artery embolization for symptomatic leiomyoma. J-Am-Assoc-Gynecol, Laparosc,2002 Feb, 9(1):70-72.
[22]Robert P. Vaginal expulsion of Submucosal fibroids after uterine artery embolization---A report of 3 cases.
[23]Vashisht-A. Fatal septicaemia after fibroid embolization. Lancet,1999, Jul 24,354(9175):307-308.
[24]Bnunereau L, Herbreteau D, Gallas S, et al. Uterine artery embolization intheprimary treatment of uterine ldomyo-mas[J]. AIR Am J Roentgenol,2000, 175(5):1276-1272.
[25]陈晓明,杜娟,左约维,等。子宫肌瘤导管栓塞治疗的临床与病理研究。中华放射杂志,2001,35(8)：595-599。
[26]Katsumori,Nakajima, et al. uterine artely embolization using gelatin sponge particles alone for age, et al. Fibroid calcification after uterine artery embolization: ultrasonographic y,2000,215(2):428-431
[27]Spies, Benenati, et al. Initial experience with use of tris-acryl gelatin microspheres for, uterine artery embolization for leiomyoma. J-Vasc-Interv-Radiol,2001,Sep,12(9):1059-63.
[28]李茂全,张庆,夏文龙,等。PVA与丝线段栓塞子宫肌瘤的对照研究。中华实用医学,2002,4(13)：36-38。
[29]Pelage, polyvinyl alcohol particles size for uterine artery embolization. Radiology,2001,Feb,218(2):605-6.
[30]Chrisman HB, Saker MB, Ryu RK, etal. Th eimpact ofuterinefibroid embolizationon resumption of mens.3 andovarian function[J]. J Vasc Interv Badiol, 2000,11(6):699-703.
[31]Vashisht A, Studd, Carey AH, etal. Fibroid embolization:athnique not without significant complications[J]. BJOG,2000,107(9):1166-1170.
[32]Ravina JH。AymantA, Ciraru Vigneon N, etal. Arterial embolization ofu. terlne myoma:results apropos of 286cases[J]. J Gynecol Obstet Biol Reprod(Parise), 2000,29(3):272-275.
[33]Pron G, Simons M, Common A, et al. Uterine embolization for sym ptoma ticflbroids:sarcoma, pregnancy an d othern Ison8 for treatment relapse or failure. SMIT/CIMIT 11th, ScientificMeeting[C]. Boston, Sept,1999.
[2]Ravina JH, Herbreteau D, Ciraru-Vigneron N, et al. Arterial embolization to treatment uterin emyomata[J]. Lancet,1995,346(s976):671-672.
[3]陈春林.子宫动脉栓塞治疗子宫肌瘤的适应证及临床疗效[J].实用妇产杂志,2007,23(12)：714-716.
[4]Ravina JH, Herbreteau D, Ciraru-Vigneron N, et al. Arterial embolization to treatment uterin emyomata[J]. Lancet,1995,346(s976):671-672.
[5]Hutchins FL, Jr Oorthington Kitsch R, Berrowitz RP. Selective utmirmartery embolization as primary treatment for symptomatic Leiomyomatauteri[J]. J Am Assoc Gyneeol Laparme,1999,6(3):279-284.
[6]刘晋波,王文新,高平,等.子宫动脉栓塞术治疗子宫肌瘤的技术应用[J].中国医学影像技术,2003,19(1)：95-97.
[7]陈晓明,杜娟,左约维,等。子宫肌瘤导管栓塞治疗的临床与病理研究。中华放射杂志,2001,35(8)：595-599。
[8]Gray P, Lisle A, et al. Pathologic findings in a uterine leiomyoma after bilateral uterine artery embolization. JVIR,1999,10:891-4.
[9]Nicholson, Pelage, et al. Fibroid calcification after uterine artery embolization: ultrasonographic appearance and pathology. JVIR,2001, Apr,12(4):448-6.
[10]Worthington-Kirsch RL, Popky GL Hutchins FL. Uterine Arterial Embolization for the Management of Leiomyoimas:Quality-of Life as Sessment and Clinical"Response[J]. Radiology,1998,208(3):625-629.
[11]Pelage JP, le Dref O, Soyer P, et al. Fibroid Related Menorrhagia:Treatment with Superselective Embolization of the U terine Arteries and Midterm Follow up[J]. Radiology,2000,215(2):428-431
[12]Bradley E A, Reidy JF, Forman RG, et al. Transcatheter Uterine Artery Embolization to Treat Large Uterine Fibroid[J]. Br Obstet Gynaecd,1998。105(2): 235-240.
[13]Ravina JH。 AymantA, Ciraru Vigneon N, etal. Arterial embolization ofu. terlne myoma:results apropos of 286cases[J]. J Gynecol Obstet Biol Reprod(Parise), 2000,29(3):272-275.
[14]谭伟,柯要军。姜陵。等.子宫动脉栓塞治疗子宫肌瘤的中远期随访研究[J].中华放射学杂志,2003。37(7)：648-653.
[15]Bnunereau L, Herbreteau D, Gallas S, et al. Uterine artery embolization intheprimary treatment of uterine ldomyo-mas[J]. AIR Am J Roentgenol,2000, 175(5):1276-1272.
[16]Katsumori,Nakajima, et al. uterine artely embolization using gelatin sponge particles alone for age, et al. Fibroid calcification after uterine artery embolization: ultrasonographic y,2000,215(2):428-431
[17]Spies, Benenati, et al. Initial experience with use of tris-acryl gelatin microspheres for, uterine artery embolization for leiomyoma. J-Vasc-Interv-Radiol,2001,Sep,12(9):1059-63.
[18]李茂全,张庆,夏文龙,等。PVA与丝线段栓塞子宫肌瘤的对照研究。中华实用医学,2002,4(13)：36-38。
[19]Pelage, polyvinyl alcohol particles size for uterine artery embolization. Radiology,2001,Feb,218(2):605-6.
[20]雷蔚华。陈春林,刘萍,等.患者自控镇痛在动脉栓塞治疗子宫肌瘤围手术期中的应用[J].现代妇产科进展。2001,10(2)：102-104.
[21]陈俊,吴大哲,刘裕恒.不同镇痛方法在子宫肌瘤介人治疗中的效果分析[J].放射学实践。2003,18(10)：787-788.
[22]崔竹梅。子宫动脉栓塞治疗症状性子宫肌瘤。世界医学杂志,2000,4(6)：22-27.
[23]Goodwin SC,Vedantham S,Mulucsa B,et al. Uterine artery em2bolization for uterine fibroids:Result of a pilot study [J]. JVIR,1997,8 (3):517-526.
[24]Payne J F,Haney AF. Serious complications of uterine artery em2bolization for conservative treatment of fibroids [J]. Fertil Steril,2003,79 (1):128-131.
[25]Ravina J H,Bouret JM,Ciraru2Vigneron N,et al. Recourse to particular artrtial embolization in the treatmentof some uterine [J].Bull Acad Natl Med,1997,181:233-243.
[26]Bradley EA, Reidy J F, Forman RG, et al. Trancather uterineartery embolisation to treat large uterine fibroids[J].Br J ObstetGnaecol,1998,105:235-240.
[27]Mclucas, Adler, et al。Uterine fibroid embolization:nonsurgical treatment for symptomatic fibroids。J-Am-Coll-Surg,2001 Jan;192(1):95-105.
[28]谭伟,柯要军。子宫动脉栓塞治疗子宫肌瘤的临床应用研究。中国医学计算机成像杂志,2000,6(2)：124-128。
[29]Watson, Walker, etd. Uterine artery embolization for the treatment of symptomatic fibroid in 114 women:reduction in size of the fibroids and women's views of the treatment. BJOG,2002 Feb,109(2):129-135.
[30]Jean-Pierre P, Olivier LD, Philippe S, et al, Fibroid-related menorrhagia:treatment with superselective embolization of the arteries and midterm follow up, Radiology.2000,215:428-431.
[31]Worthington-Kirsch RL, Popky GL, Hutchins FL, Uterine arterial emlolization for the management of leiomyomas:quality-of-life and clinical response, Radiology,1998,208:625-629.
[32]Broder MS, Goodwin S, Chen G, et al. Comparison of Long-term Outcomes of Myomectomy and Uterine Artery Embolization[J]. Obstet Gynecol,2002,100(5Pt 1):864-868. 现的子宫破裂及胎盘功能情况知之甚少。由于上述原因,对于年龄较小、尚未生育和希望保留生育能力的患者来说,采用UAE应慎重考虑。为此,Pelage提出了栓塞程度的标准：1、与肌瘤有关的肿瘤血管消失；2、子宫动脉远端学流变慢；3、子宫动脉主干、包括支配卵巢和阴道的血管保留。
综上所诉,UAE作为治疗症状性子宫肌瘤的一个重要手段,虽然取得了较好的效果,但尚有许多工作有待研究。1、它的远期疗效如何,目前尚缺乏大宗病例报道；2、如何尽量预防及有效治疗其并发症,如对卵巢的功能及生育能力的影响；3、明确各种子宫肌瘤的血供特点,从而合理选择适应症,制定规范化的介入治疗方案等,都是UAE面临的研究课题。
[1]Reidy JF, Bradley EA. Uterine artery embolization to treat uterine fibroids [J]. Cardiovasc Intervent Radiol,1998,21(7):357-359.
[2]Ravina JH, Herbreteau D, Ciraru-Vigneron N, et al. Arterial embolization to treatment uterin emyomata[J]. Lancet,1995,346(s976):671-672.
[3]Hutchins FL, Jr Oorthington Kitsch R, Berrowitz RP. Selective utmirmartery embolization as primary treatment for symptomatic Leiomyomatauteri[J]. J Am Assoc Gyneeol Laparme,1999,6(3):279-284.
[4]刘晋波,王文新,高平,等.子宫动脉栓塞术治疗子宫肌瘤的技术应用[J].中国医学影像技术,2003,19(1)：95-97.
[5]Pelage, Laurent, et al. Arterial blood supply to the uterus in nonpregnant sheep:A pertinent model for clinical ptactice Inter-Radiol,2001, Dec,36(12):721-5.
[6]Gray P, Lisle A, et al. Pathologic findings in a uterine leiomyoma after bilateral uterine artery embolization. JVIR,1999,10:891-4.
[7]Nicholson, Pelage, et al. Fibroid calcification after uterine artery embolization: ultrasonographic appearance and pathology. JVIR,2001, Apr,12(4):448-6.
[8]Worthington-Kirsch RL, Popky GL Hutchins FL. Uterine Arterial Embolization for the Management of Leiomyoimas:Quality-of Life as Sessment and Clinical"Response[J]. Radiology,1998,208(3):625-629.
[9]Pelage JP, le Dref O, Soyer P, et al. Fibroid Related Menorrhagia:Treatment with Superselective Embolization of the U terine Arteries and Midterm Follow up[J]. Radiology,2000,215(2):428-431
[10]Bradley EA, Reidy JF, Forman RG, et al. Transcatheter Uterine Artery Embolization to Treat Large Uterine Fibroid[J]. Br Obstet Gynaecd,1998。105(2): 235-240.
[11]Mclucas, Adler, et al。 Uterine fibroid embolization:nonsurgical treatment for symptomatic fibroids。 J-Am-Coll-Surg,2001 Jan; 192(1):95-105.
[12]谭伟,柯要军。子宫动脉栓塞治疗子宫肌瘤的临床应用研究。中国医学计算机成像杂志,2000,6(2)：124-128。
[13]Watson, Walker, etd. Uterine artery embolization for the treatment of symptomatic fibroid in 114 women:reduction in size of the fibroids and women's views of the treatment. BJOQ2002 Feb,109(2):129-135.
[14]Broder MS, Goodwin S, Chen G, et al. Comparison of Long-term Outcomes of Myomectomy and Uterine Artery Embolization[J]. Obstet Gynecol,2002,100(5Pt 1):864-868.
[15]谭伟,柯要军。姜陵。等.子宫动脉栓塞治疗子宫肌瘤的中远期随访研究[J].中华放射学杂志,2003。37(7)：648-653.
[16]雷蔚华。陈春林,刘萍,等.患者自控镇痛在动脉栓塞治疗子宫肌瘤围手术期中的应用[J].现代妇产科进展。2001,10(2)：102-104.
[17]陈俊，吴大哲,刘裕恒.不同镇痛方法在子宫肌瘤介人治疗中的效果分析[J].放射学实践。2003,18(10)：787-788.
[18]崔竹梅,子宫动脉栓塞治疗症状性子宫肌瘤。世界医学杂志,2000,4(6)：22-27.
[19]Pollard, Goldberg, et al. Prolapsed cervical myoma after uterine artery embolization A case report. J-Reprod-Med,2001, May,46(5):499-500.
[20]Bradley EA, Reidy JF, Forman RG, et al. Transcatheter Uterine Artery Embolization to Treat Large Uterine Fibroid[J]. Br Obstet Gynaecd,1998 。105(2) symptomatic uterine fibroids:midterm results. AJR-Am-J-Roentgenol,2002:Jan,178(1):135-9.
[21]Hameed, Heller, et al. Squamous metaplasia of endometrium after uterine artery embolization for symptomatic leiomyoma. J-Am-Assoc-Gynecol, Laparosc,2002 Feb, 9(1):70-72.
[22]Robert P. Vaginal expulsion of Submucosal fibroids after uterine artery embolization---A report of 3 cases.
[23]Vashisht-A. Fatal septicaemia after fibroid embolization. Lancet,1999, Jul 24,354(9175):307-308.
[24]Bnunereau L, Herbreteau D, Gallas S, et al. Uterine artery embolization intheprimary treatment of uterine ldomyo-mas[J]. AIR Am J Roentgenol,2000, 175(5):1276-1272.
[25]陈晓明,杜娟,左约维,等。子宫肌瘤导管栓塞治疗的临床与病理研究。中华放射杂志,2001,35(8)：595-599。
[26]Katsumori,Nakajima, et al. uterine artely embolization using gelatin sponge particles alone for age, et al. Fibroid calcification after uterine artery embolization: ultrasonographic y,2000,215(2):428-431
[27]Spies, Benenati, et al. Initial experience with use of tris-acryl gelatin microspheres for, uterine artery embolization for leiomyoma. J-Vasc-Interv-Radiol,2001,Sep,12(9):1059-63.
[28]李茂全,张庆,夏文龙,等。PVA与丝线段栓塞子宫肌瘤的对照研究。中华实用医学,2002,4(13)：36-38。
[29]Pelage, polyvinyl alcohol particles size for uterine artery embolization. Radiology,2001,Feb,218(2):605-6.
[30]Chrisman HB, Saker MB, Ryu RK, etal. Th eimpact ofuterinefibroid embolizationon resumption of mens.3 andovarian function[J]. J Vasc Interv Badiol, 2000,11(6):699-703.
[31]Vashisht A, Studd, Carey AH, etal. Fibroid embolization:athnique not without significant complications[J]. BJOG,2000,107(9):1166-1170.
[32]Ravina JH。AymantA, Ciraru Vigneon N, etal. Arterial embolization ofu. terlne myoma:results apropos of 286cases[J]. J Gynecol Obstet Biol Reprod(Parise), 2000,29(3):272-275.
[33]Pron G, Simons M, Common A, et al. Uterine embolization for sym ptoma ticflbroids:sarcoma, pregnancy an d othern Ison8 for treatment relapse or failure. SMIT/CIMIT 11th, ScientificMeeting[C]. Boston, Sept,1999.
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