子宫肌瘤栓塞治疗的进展PPT课件.ppt

子宫肌瘤栓塞治疗的进展,1,栓塞在子宫肌瘤治疗手段中地位的确立(2007),2,1995年Ravina首先在Lancet上报道了子宫肌瘤栓塞治疗；,RavinaJH,HerbreteauD,Ciraru-VigneronNetal.Arterialembolisationtotreatuterinemyomata.Lancet1995;346:671672,3,2004年美国妇产科学会认可子宫肌瘤栓塞的作用；,4,两个随机对照研究结果最终确立栓塞在子宫肌瘤治疗手段的地位,RESTtrialEdwardsRD,MossJG,LumsdenMAetal.Uterine-arteryembolizationversussurgeryforsymptomaticuterinefibroids.NEnglJMed2007;356:360370.EMMYtrialVolkersNA,HehenkampWJ,BirnieEetal.Uterinearteryembolizationversushysterectomyinthetreatmentofsymptomaticuterinefibroids:2yearsoutcomefromtherandomizedEMMYtrial.AmJObstetGynecol2007;196(6):519.e1e11.,5,最终确认栓塞治疗是子宫肌瘤中除子宫切除外的一种安全有效的治疗方法！,6,长期疗效,7,SpiesJB,BrunoJ,Czeyda-PommersheimFetal.Long-termoutcomeofuterinearteryembolizationofleiomyomata.ObstetGynecol2005;106:933939.,8,KatsumoriT,KasaharaT186:848854.,9,WalkerWJ113:464468.,10,我院500例子宫肌瘤栓塞治疗随访的有效率,11,子宫肌瘤栓塞治疗的有效率长期而稳定！,12,影响疗效的因素,13,影响疗效的因素,栓塞不完全子宫动脉主干栓塞不完全仅作单侧子宫动脉栓塞子宫栓塞不完全其他供血动脉（卵巢动脉、变异子宫动脉）肌瘤过大诊断问题（月经量过多或经期延长！）插管技术,14,子宫肌瘤栓塞治疗并发症,15,EdwardsRD,MossJG,LumsdenMAetal.Uterine-arteryembolizationversussurgeryforsymptomaticuterinefibroids.NEnglJMed2007;356:360370.VolkersNA,HehenkampWJ,BirnieEetal.Uterinearteryembolizationversushysterectomyinthetreatmentofsymptomaticuterinefibroids:2yearsoutcomefromtherandomizedEMMYtrial.AmJObstetGynecol2007;196(6):519.e1e11.SiskinGP,Shlansky-GoldbergRD,GoodwinSCetal.Aprospectivemulticentercomparativestudybetweenmyomectomyanduterinearteryembolizationwithpolyvinylalcoholmicrospheres:longtermclinicaloutcomesinpatientswithsymptomaticuterinefibroids.JVascIntervRadiol2006;17:12871295.DuttonS,HirstA,McPhersonKetal.AUKmulticentreretrospectivecohortstudycomparinghysterectomyanduterinearteryembolisationforthetreatmentofsymptomaticuterinefibroids(HOPEFULstudy):mainresultsonmedium-termsafetyandefficacy.BrJObstetGynaecol2007;114:13401351.WuO,BriggsA,DuttonSetal.Uterinearteryembolisationorhysterectomyforthetreatmentofsymptomaticuterinefibroids:acost-utilityanalysisoftheHOPEFULstudy.BrJObstetGynaecol2007;114:13521362.,16,我院子宫肌瘤栓塞术后并发症,轻微并发症腹痛27/500（5.4%）发热410/500（82%）阴道出血432/500（86.4%）血尿11/500（2.2%）严重并发症（6/500，2.6%）膀胱误栓1/500（0.2%）短暂性闭经3/500（0.6%）卵巢衰竭3/500（0.6%）栓塞失败1/500（0.2%）栓塞后肌瘤脱落4/500（0.8%）栓塞后盆腔感染1/500（0.2%）术后复发10/500（2%）,17,栓塞对卵巢功能的影响,18,2001年Spies认为栓塞仅对年龄大于45岁的患者有影响，术后闭经发生率为14%；2003年Pron却发现小于40岁的3%患者出现术后闭经；虽然较多的研究通过FSH在栓塞前后的变化来说明栓塞治疗对卵巢较少的影响，但是病例数均较少。这类研究没有考虑到栓塞中常见的卵巢子宫动脉吻合问题，KIM的研究发现若出现该吻合则患者术后会出现FSH的上移。,SpiesJB,RothAR,GonsalvesSMetal.Ovarianfunctionafteruterinearteryembolizationforleiomyomata:assessmentwithuseofserumfolliclestimulatinghormoneassay.JVascIntervRadiol2001;12:437442.PronG,BennettJ,CommonAetal.TheOntarioUterineFibroidEmbolizationTrial.Part2.Uterinefibroidreductionandsymptomreliefafteruterinearteryembolizationforfibroids.FertilSteril2003;79:120127.SpiesJB,RothAR,GonsalvesSMetal.Ovarianfunctionafteruterinearteryembolizationforleiomyomata:assessmentwithuseofserumfolliclestimulatinghormoneassay.JVascIntervRadiol2001;12:437442.AhmadA,QadanL,HassanNetal.Uterinearteryembolizationtreatmentofuterinefibroids:effectonovarianfunctioninyoungerwomen.JVascIntervRadiol2002;13:10171020.HealeyS,BuzagloK,SetiLetal.Ovarianfunctionafteruterinearteryembolizationandhysterectomy.JAmAssocGynecolLaparosc2004;11:348352.TropeanoG,DiStasiC,LitwickaKetal.Uterinearteryembolizationforfibroidsdoesnothaveadverseeffectsonovarianreserveinregularlycyclingwomenyoungerthan40years.FertilSteril2004;81:10551061.HovsepianDM,RattsVS,RodriguezMetal.Aprospectivecomparisonoftheimpactofuterinearteryembolization,myomectomy,andhysterectomyonovarianfunction.JVascIntervRadiol2006;17:11111115.KimHS,TsaiJ,LeeJMetal.Effectsofutero-ovariananastomosesonbasalfollicle-stimulatinghormonelevelchangeafteruterinearteryembolizationwithtris-acrylgelatinmicrospheres.JVascIntervRadiol2006;17:965971.KimHS,ThonseVR,JudsonKetal.Utero-ovariananastomosis:histopathologiccorrelationafteruterinearteryembolizationwithorwithoutovarianarteryembolization.JVascIntervRadiol2007;18:3139.,19,如何处理子宫动脉造影中卵巢支显影的病例？,20,我院在子宫肌瘤栓塞子宫动脉造影中其双侧卵巢支显影处理的临床研究,21,22,子宫肌瘤栓塞患者,子宫动脉造影其双侧卵巢支显影,非显影组,显影明胶海绵组,显影组,非显影聚乙烯醇组,非显影明胶海绵组,23,三组病例临床症状改善情况,*三组进行组组间2检验，统计学未见组组间疗效有差异性。,24,三组病例栓塞前后FSH的变化,#三组独立t检验分析，和*三组组间方差分析，FSH变化无统计学差异性,25,对于肌瘤栓塞中子宫动脉造影其双侧卵巢支显影病例可以采用自制明胶海绵颗粒为栓塞材料进行处理，其疗效可以保证且对卵巢功能影响不大。,26,目前子宫肌瘤栓塞对卵巢功能的影响尚无结论！,27,子宫肌瘤栓塞治疗对怀孕与生育的影响,28,目前，对有生育要求的患者不建议使用栓塞治疗。,缺乏对栓塞治疗对怀孕影响的研究结果目前栓塞对怀孕影响的研究仅限于个案报道和小病例报道。缺乏足够的证据支持栓塞治疗对怀孕和生殖的益处。,29,腹腔镜子宫动脉结扎和栓塞治疗肌瘤对怀孕的随机多中心对照研究2008,Holub,Z,Mara,M,KuzelDetal.Pregnancyoutcomesafteruterinearteryocclusion:prospectivemulticentricstudyFertilityandSterility2007,30,腹腔镜子宫动脉结扎和栓塞治疗肌瘤对怀孕的随机多中心对照研究2008,Holub,Z,Mara,M,KuzelDetal.Pregnancyoutcomesafteruterinearteryocclusi