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目的基于数字减影血管造影探讨子宫平滑肌瘤血供特点。方法对518例行子宫动脉栓塞术(UAE)病人的供血动脉、子宫平滑肌瘤血管分布和卵巢血管网的可视化进行研究。病人年龄22~54岁,平均(38.97±6.09)岁。通过子宫平滑肌瘤的供血血管以及比较子宫平滑肌瘤与正常子宫肌层强化程度确定血管分布等级来分析子宫平滑肌瘤的血供类型。结果 3.28%的病人的子宫平滑肌瘤血供无法分类。88.61%的子宫平滑肌瘤完全由子宫动脉供血,8.11%有卵巢动脉参与部分供血,0.39%完全由卵巢动脉供血。子宫平滑肌瘤的血供分为单侧优势、双侧平衡、单一单侧子宫动脉和单一卵巢动脉4类,比例分别为36.48%、49.23%、10.62%和0.39%。子宫平滑肌瘤血管分布分为极富血供型(8.69%)、富血供型(46.14%)、等血供型(33.39%)和乏血供型(11.78%)。结论子宫平滑肌瘤由双侧子宫动脉供血同时血供丰富的比例大约为50%。然而在行UAE时也应密切关注侧支循环。要点①使用数字减影血管造影来研究子宫平滑肌瘤的血供。②大部分子宫平滑肌瘤由双侧子宫动脉供血。③行栓塞术过程中应注意侧支循环。
Objective To study the blood supply characteristics of uterine leiomyoma based on digital subtraction angiography. Methods The visualization of blood supply artery, uterine leiomyoma and ovarian vascular network in 518 patients undergoing uterine artery embolization (UAE) was studied. Patients aged 22 to 54 years old, with an average (38.97 ± 6.09) years. Uterine leiomyoma blood vessels and uterine leiomyomas compared with normal myometrial enhancement level to determine the level of vascular distribution to analyze the type of uterine leiomyoma blood supply. Results 3.28% of patients with uterine leiomyoma blood supply can not be classified. 88.61% of uterine leiomyoma was completely supplied by uterine artery, 8.11% had ovarian artery involved in partial supply of blood and 0.39% completely by ovarian artery. Uterine leiomyoma blood supply is divided into unilateral dominance, bilateral balance, single unilateral uterine artery and single ovarian artery in 4 categories, the proportion was 36.48%, 49.23%, 10.62% and 0.39%. Uterine smooth muscle tumor vascular distribution is divided into very rich blood supply (8.69%), rich blood supply (46.14%), and other blood supply (33.39%) and lack of blood supply (11.78%). Conclusion Uterine leiomyoma is supplied by the bilateral uterine artery with a blood supply of about 50%. However, in the line UAE should pay close attention to collateral circulation. Points ① Use digital subtraction angiography to study the uterine leiomyoma blood supply. ② most of the uterine leiomyomas by bilateral uterine artery blood supply. ③ embolization should pay attention to the process of collateral circulation.