子宫肌瘤栓塞治疗课件

子宫肌瘤栓塞治疗的进展子宫肌瘤栓塞治疗栓塞在子宫肌瘤治疗手段中地位的确立(2007)子宫肌瘤栓塞治疗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;346:671–672子宫肌瘤栓塞治疗2004年美国妇产科学会认可子宫肌瘤栓塞的作用；子宫肌瘤栓塞治疗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;356:360–370.EMMYtrial

VolkersNA,HehenkampWJ,BirnieEetal.Uterinearteryembolizationversushysterectomyinthetreatmentofsymptomaticuterinefibroids:2years’outcomefromtherandomizedEMMYtrial.AmJObstetGynecol2007;196(6):519.e1–e11.子宫肌瘤栓塞治疗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！子宫肌瘤栓塞治疗长期疗效子宫肌瘤栓塞治疗SpiesJB,BrunoJ,Czeyda-PommersheimFetal.Long-termoutcomeofuterinearteryembolizationofleiomyomata.ObstetGynecol2005;106:933–939.子宫肌瘤栓塞治疗KatsumoriT,KasaharaT&AkazawaK.Long-termoutcomesofuterinearteryembolizationusinggelatinspongeparticlesaloneforsymptomaticfibroids.AJRAmJRoentgenol2006;186:848–854.子宫肌瘤栓塞治疗WalkerWJ&Barton-SmithP.Long-termfollowupofuterinearteryembolisation–aneffective

alternativeinthetreatmentoffibroids.BrJObstetGynaecol2006;113:464–468.

肌瘤栓塞后5-7年的结果月经量改善压迫症状是否愿意选择和推荐UAE需要进一步治疗75%80%88%16%子宫肌瘤栓塞治疗我院500例子宫肌瘤栓塞治疗随访的有效率子宫肌瘤栓塞治疗子宫肌瘤栓塞治疗的有效率长期而稳定！子宫肌瘤栓塞治疗影响疗效的因素子宫肌瘤栓塞治疗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！）插管技术子宫肌瘤栓塞治疗子宫肌瘤栓塞治疗并发症子宫肌瘤栓塞治疗

EdwardsRD,MossJG,LumsdenMAetal.Uterine-arteryembolizationversussurgeryforsymptomaticuterinefibroids.NEnglJMed2007;356:360–370.VolkersNA,HehenkampWJ,BirnieEetal.Uterinearteryembolizationversushysterectomyinthetreatmentofsymptomaticuterinefibroids:2years’outcomefromtherandomizedEMMYtrial.AmJObstetGynecol2007;196(6):519.e1–e11.SiskinGP,Shlansky-GoldbergRD,GoodwinSCetal.Aprospectivemulticentercomparativestudybetweenmyomectomyanduterinearteryembolizationwithpolyvinylalcoholmicrospheres:longtermclinicaloutcomesinpatientswithsymptomaticuterinefibroids.JVascIntervRadiol2006;17:1287–1295.DuttonS,HirstA,McPhersonKetal.AUKmulticentreretrospectivecohortstudycomparinghysterectomyanduterinearteryembolisationforthetreatmentofsymptomaticuterinefibroids(HOPEFULstudy):mainresultsonmedium-termsafetyandefficacy.BrJObstetGynaecol2007;114:1340–1351.WuO,BriggsA,DuttonSetal.Uterinearteryembolisationorhysterectomyforthetreatmentofsymptomaticuterinefibroids:acost-utilityanalysisoftheHOPEFULstudy.BrJObstetGynaecol2007;114:1352–1362.子宫肌瘤栓塞后并发症发生情况

病例数轻微并发症严重并发症Razavi

(2003)6711%Siskin（2006）7726%EMMY（2006）8864%4.9%REST(2006)10634%12%HOPEFUL(2007)64919%

子宫肌瘤栓塞治疗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%）子宫肌瘤栓塞治疗栓塞对卵巢功能的影响子宫肌瘤栓塞治疗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;12:437–442.PronG,BennettJ,CommonAetal.TheOntarioUterineFibroidEmbolizationTrial.Part2.Uterinefibroidreductionandsymptomreliefafteruterinearteryembolizationforfibroids.FertilSteril2003;79:120–127.SpiesJB,RothAR,GonsalvesSMetal.Ovarianfunctionafteruterinearteryembolizationforleiomyomata:assessmentwithuseofserumfolliclestimulatinghormoneassay.JVascIntervRadiol2001;12:437–442.AhmadA,QadanL,HassanNetal.Uterinearteryembolizationtreatmentofuterinefibroids:effectonovarianfunctioninyoungerwomen.JVascIntervRadiol2002;13:1017–1020.HealeyS,BuzagloK,SetiLetal.Ovarianfunctionafteruterinearteryembolizationandhysterectomy.JAmAssocGynecolLaparosc2004;11:348–352.TropeanoG,DiStasiC,LitwickaKetal.Uterinearteryembolizationforfibroidsdoesnothaveadverseeffectsonovarianreserveinregularlycyclingwomenyoungerthan40years.FertilSteril2004;81:1055–1061.HovsepianDM,RattsVS,RodriguezMetal.Aprospectivecomparisonoftheimpactofuterinearteryembolization,myomectomy,andhysterectomyonovarianfunction.JVascIntervRadiol2006;17:1111–1115.KimHS,TsaiJ,LeeJMetal.Effectsofutero-ovariananastomosesonbasalfollicle-stimulatinghormonelevelchangeafteruterinearteryembolizationwithtris-acrylgelatinmicrospheres.JVascIntervRadiol2006;17:965–971.KimHS,ThonseVR,JudsonKetal.Utero-ovariananastomosis:histopathologiccorrelationafteruterinearteryembolizationwithorwithoutovarianarteryembolization.JVascIntervRadiol2007;18:31–39.子宫肌瘤栓塞治疗如何处理子宫动脉造影中卵巢支显影的病例？子宫肌瘤栓塞治疗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子宫肌瘤栓塞治疗子宫动脉造影中卵巢支显影情况双侧卵巢支显影单侧卵巢支显影无卵巢支显影

53（41.4%，53/128）31（24.2%，31/128）44（34.3%，44/128）子宫肌瘤栓塞治疗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子宫肌瘤栓塞治疗三组病例临床症状改善情况

显影组非显影聚乙烯醇组非显影明胶海绵组栓塞后月经量恢复正常20/2020/2117/19栓塞前压迫症状消失1/21/13/3总体症状改善21/22，95.4%21/22，95.4%20/22，90.9%χ2值0.5323*P>0.05*三组进行组组间χ2检验，统计学未见组组间疗效有差异性。子宫肌瘤栓塞治疗三组病例栓塞前后FSH的变化

显影组非显影聚乙烯醇组非显影明胶海绵组栓塞前FSH(IU/L)11.10±1.5013.07±1.1811.45±1.74栓塞后FSH(IU/L)11.26±0.8913.21±1.2211.83±1.35P（t值）#>0.05(0.6919)>0.05(0.7121)>0.05(2.8533)P（F值）*>0.05(0.4096)#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子宫肌瘤栓塞治疗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。

子宫肌瘤栓塞治疗目前子宫肌瘤栓塞对卵巢功能的影响尚无结论！子宫肌瘤栓塞治疗子宫肌瘤栓塞治疗对怀孕与生育的影响子宫肌瘤栓塞治疗目前，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。子宫肌瘤栓塞治疗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腹腔镜子宫动脉结扎术与栓塞治疗后生育情况

腹腔镜子宫动脉结扎术栓塞治疗P值怀孕病例3820—

妊娠病例4028—

术后到怀孕时间（月）8.6±2.79.1±2.5NS怀孕率（%）38/81(46.9)

20/39(51.2)NS自然受孕39/40(97.5)27/28(96.4)NS诱导排卵1/40(2.5)0/28(0)NS试管受精0/40(0)1/28(3.5)NS流产率4/36(11.1)14/25(56)<.001正在妊娠6/40(15)1/28(4.1)NS异位妊娠1/40(2.5)1/28(3.5)NS中止妊娠1/40(2.5)2/28(7.1)NSHolub,Z,Mara,M,KuzelDetal.Pregnancyoutcomesafteruterinearteryocclusion:prospectivemulticentricstudyFertilityandSterility2007,子宫肌瘤栓塞治疗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腹腔镜子宫动脉结扎术与栓塞治疗后生产和新生儿情况

腹腔镜子宫动脉结扎术26例栓塞10例早产4(15.3)2(20.0)自然生产7(26.9)2(20.0)剖腹产19(73.1)8(80.0)并发症显露异常22产后出血02前置胎盘10子宫破裂00先兆子痫01新生儿胎龄（周）38