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目的:探讨分次栓塞子宫动脉治疗巨大子宫肌瘤的方法和临床疗效。方法:对18例巨大子宫肌瘤患者进行选择性子宫动脉造影及栓塞治疗。治疗前观察其子宫肌瘤血供特点、瘤体大小;其中10例栓塞材料用自制真丝线段颗粒(7号手术缝线),8例用聚乙烯醇微粒(PVA,300～500!m)及明胶海绵颗粒栓塞子宫动脉,栓塞治疗后造影证实子宫动脉栓塞的变化情况并随访。结果:血管造影显示子宫肌瘤血液供应丰富,主要由子宫动脉供血,左侧为主的7例(约占39%),右侧为主的10例(约占56%),双侧接近相同供血的1例(约占5%)。随访18例患者,随诊5年超声检查结果,子宫及肌瘤体积均明显缩小,子宫体积缩小33.7%～51.6%,肌瘤体积缩小48.3%～75.8%(P<0.01),5年内未发现术后再发肌瘤。结论:采用两次子宫动脉栓塞,使用普通导管、真丝线段栓塞经济有效;使用微导管采用远端聚乙烯微球近端加明胶海绵颗粒确切安全,疼痛等症状明显较一次栓塞轻,疗效好。
Objective: To investigate the method and clinical efficacy of embolization of uterine artery embolization for huge uterine fibroids. Methods: Selective ectopic uterine artery angiography and embolization were performed on 18 patients with giant uterine fibroids. The blood supply characteristics and tumor size of uterine fibroids were observed before treatment. Among them, 10 cases of embolization materials were made with self-made silk segments (No. 7 surgical suture), 8 cases with polyvinyl alcohol particles (PVA, 300 ~ 500μm) Gelatin sponge particles embolization of the uterine artery, embolization after angiography confirmed uterine artery embolization changes and follow-up. Results: Angiography showed abundant blood supply of uterine fibroids, mainly by the uterine artery, 7 cases were mainly left (about 39%), 10 cases were mainly right (56%), the two sides were nearly the same 1 case of blood supply (about 5%). Eighteen patients were followed up for 5 years. The volume of uterus and fibroids were significantly reduced, the uterine volume was reduced by 33.7% -51.6%, the fibroids size was reduced by 48.3% -75.8% (P <0.01), but not found within 5 years Recurrence of fibroids after surgery. Conclusion: Uterine artery embolization twice, the use of ordinary catheters, silk thread embolization cost-effective; the use of microcatheter distal polyethylene microspheres plus gelatin sponge particles near the exact safety, pain and other symptoms were significantly lighter than the embolization, and good curative effect.