【摘要】 目的　分析葡聚糖微球动脉栓塞治疗子宫肌瘤的相关技术因素 ,评估该技术治疗 38例病人的初步临床疗效。方法　从 1999年 4月 - 2 0 0 1年 1月 ,对 38例子宫肌瘤患者随机采用葡聚糖微球行超选择性双侧子宫动脉栓塞治疗。患者年龄范围 2 4 - 48岁 ,平均 37 2岁。临床表现为月经过多、尿频、不孕和下腹坠痛等症状。其中浆膜下肌瘤 4例 ,粘膜下肌瘤或壁间肌瘤 34例 ,肌瘤直径 2 - 10 9cm不等。 32例为单发性肌瘤 ,6例多发性肌瘤。所有病例均采用右侧股动脉径路 ,单根猎人头导管双侧子宫动脉插管技术。栓塞用葡聚糖微球 (直径 2 2 5 - 45 0 μm)和 3- 5条明胶海绵条块。栓塞后每月进行临床和B超随访以观察临床疗效。结果　超选择插管及栓塞成功率均为 10 0 %。栓塞后 35例病人疼痛控制良好。随访 3月 ,36 (95 % )例病人临床症状改善 ;2例无效 ,占 5 %。B超随访显示肌瘤体积随时间推移进行性缩小 ,术后 6月 ,5例肌瘤消失 ,肌瘤体积平均缩小 6 8%。结论　葡聚糖微球栓塞治疗子宫肌瘤是一种微创性治疗手段 ,可使肌瘤实体进行性缩小、临床症状改善。该技术更适合于粘膜下子宫肌瘤伴月经量过多患者的临床治疗更多还原

【Abstract】 Objectives To analyze the technical aspects of uterine artery embolization with dextran microspheres and to evaluate the effectiveness of this technique as the primary treatment of uterine fibroids in a series of 38 patients.Methods Thirty-eight volunteers (age range, 24-48 years; mean, 37.2 years) with symptoms caused by uterine fibroids (menorrhagia, mass-related symptoms, and pelvic pain) were randomly included in this study. The fibroids were single in 32 patients and multiple in 6 patients. According to the tumor location, subserous fibroids were found in 4 patients and interstitial or submucosal fibroids in 34. Tumor size was from 2 to 10.9 cm in diameter. We performed embolization with a single Headhunter catheter using the right-femoral artery approach, injection of dextran microspheres (225-450 μm), and an absorbable gelatin sponge. Follow-up included clinical and sonographic examinations at one-month intervals for 6 months.Results Embolization was successfully performed in all patients. Post-procedural pain control was good in 35 (92%) patients. In most patients, symptoms were improved at 3 months (36/38, 95%). Clinical failure of the treatment occurred in only 2 patients (2/38, 5%). Progressive reduction in leiomyoma size was revealed during sonographic follow-up, and the reduction rate at the sixth month after embolization was 68%. The tumor had vanished in five submucosal fibroid patients. Histopathological tests showed that the tumor was degenerative as fibrosis and hyalinosis.Conclusions Uterine artery embolization with dextran microspheres is a micro-invasive method for the treatment of uterine fibroids. It is clinically effective in most patients and induces a progressive reduction in the size of fibroids. Based on this study, we believe that this new technique is much more suitable for submucosal fibroids with massive menorrhagia.更多还原