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目的分析子宫动脉栓塞(UAE)治疗子宫肌瘤后继发闭经的原因并探讨有效预防措施。方法对2000年1月至2007年9月海南省人民医院和黄冈市第一人民医院157例接受子宫动脉栓塞治疗的子宫肌瘤患者术后随访,回顾性分析治疗后继发闭经患者的相关资料。结果共5例继发闭经,占同期接受UAE治疗的3.18%,年龄37～48岁,平均44.3岁。5例UAE治疗时使用的栓塞剂均为平阳霉素和碘油的混合乳剂,闭经发生于治疗后的3～6个月。3例雌二醇(E2)下降、卵泡刺激素(FSH)升高,而子宫内膜正常,诊断为卵巢性闭经,其中1例雌孕激素序贯治疗7个月后月经恢复;2例子宫内膜萎缩,而E2和FSH水平正常,诊断为子宫性闭经。结论UAE治疗子宫肌瘤继发闭经的发病率低,但其严重性不容忽视。熟练而谨慎的操作并合理应用栓塞剂有助于减少和预防继发闭经的发生。
Objective To analyze the causes of secondary amenorrhea after uterine arterial embolization (UAE) and explore effective preventive measures. Methods A total of 157 patients with uterine leiomyoma who underwent uterine artery embolization were enrolled in this study from January 2000 to September 2007 in Hainan Provincial People’s Hospital and the First People’s Hospital of Huanggang City. The related data of patients with secondary amenorrhea after treatment were analyzed retrospectively. Results A total of 5 cases of secondary amenorrhea, accounting for the same period received UAE treatment of 3.18%, aged 37 to 48 years, mean 44.3 years. Five cases of UAE embolization agent used in the treatment of bleomycin and lipiodol mixed emulsion, amenorrhea occurred in the treatment of 3 to 6 months. 3 cases of estradiol (E2) decreased, follicle stimulating hormone (FSH) increased, while the normal endometrium, ovarian amenorrhea diagnosed, of which 1 case of estrogen and progesterone sequential treatment of 7 months after menstruation recovery; 2 cases of uterine Endometrial atrophy, and E2 and FSH levels were normal, the diagnosis of uterine amenorrhea. Conclusion The incidence of secondary amenorrhea in UAE treated by UAE is low, but its severity can not be ignored. Skilled and cautious operation and rational use of embolic agents can help reduce and prevent the occurrence of secondary amenorrhea.