【作者】 刘春霖；

【导师】 刘鹏程；

【作者基本信息】 汕头大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 第一部分:经子宫动脉栓塞治疗子宫肌瘤的临床研究目的研究子宫动脉栓塞术(uterine artery embolization,UAE)治疗子宫肌瘤的临床疗效。材料与方法对36例经证实患有子宫肌瘤的患者进行选择性子宫动脉造影,并以PVA颗粒为栓塞材料对双侧子宫动脉进行栓塞治疗。结果术后患者血红蛋白(hemoglobin,Hb)值由术前的(76.4±11.3)g/L恢复至(99.7±9.3)g/L,手术前后有显著性差异(P＜0.01);术后月经增多症状改善、腹痛及盆腔压迫症状缓解;术后3、6、12个月复查,肌瘤体积分别较前缩小38%、57%和69%;栓塞后瘤体影像学呈明显缺血坏死表现。结论经子宫动脉栓塞术治疗子宫肌瘤具有疗效确切、创伤小、保留子宫,并可重复治疗的优势,是一种微创治疗子宫肌瘤的有效方法。第二部分:UAE与经腹肌瘤切除术治疗子宫肌瘤疗效对比目的通过比较子宫肌瘤的UAE治疗与开腹肌瘤切除术的临床疗效和并发症等方面,探讨子宫肌瘤UAE治疗作为临床主要治疗方法之一的可行性。材料与方法收集和整理我院2003年到2008年期间症状性子宫肌瘤患者76例,其中UAE治疗患者36例,开腹肌瘤切除术患者40例。两组平均年龄分别是36.58±6.95岁和38.78±8.77岁。通过查阅诊疗记录以及电话问卷调查的形式对两组患者术后临床症状的变化、相关并发症的出现情况等方面进行回顾性分析。结果UAE治疗组和开腹肌瘤切除术组(以下简称手术组)平均随访时间为16.3±7.9和14.9±9.3个月,两组病例的月经增多症状控制率分别是76.7%和62.9%(p＞0.05),腹痛的缓解率分别为75.0%和38.1%(p＜0.05),盆腔压迫症状改善率分别是53.3%和89.5%(p＜0.05);两组患者并发症的发生率分别为11.1%和32.5%(p＜0.05);UAE治疗组住院时间较手术组平均短2.3天(p＜0.05),但住院平均费用多出5800元(p＜0.01)。结论经子宫动脉栓塞术较开腹肌瘤切除术治疗子宫肌瘤损伤更小、更安全;在临床症状的控制方面,与手术治疗疗效相当,且其并发症发生率较手术组低,因此可作为临床治疗子宫肌瘤的主要方法之一。更多还原

【Abstract】 PartⅠClinical Research in Uterine Artery Embolization for Uterine FibroidsObjective To explore the therapeutic effect of uterine artery embolization (UAE) for uterine fibroids.Materials and Methods 36 cases confrmed with uterine fibroids were performing selective uterine arteriography and bilateral uterine arteriy embolization with PVA particles.Results After UAE,the Hemoglobin(Hb) value recover to(99.7±9.3) g/L from preoperative(76.4±11.3) g / L.The difference between two sets of data showed statistical significance(P＜0.01).Postoperative menorrhagia,abdominal pain and oppression symptm of pelvis have significant improvement.3 months,6months and 12 months after UAE,the myoma volume decreased by 38%,57%,69%,respectively: After embolization,uterine fibroids imaging character showed obviously avascular necrosis.Conclusions UAE was an effective,less trauma and repeatable with reservation of the uterine,which can be a effective minimally invasive treatment for uterine fibroids. PartⅡComparative Study of UAE and Myomectomy with Laparotomy in treatment Uterine FibroidsObjective To compared UAE with abdominal myomectomy at clinical efficacy and complications in uterine fibroid therapy,to explore the feasibility of UAEas one of the main clinical treatment for uterine fibroids.Material and Methods We collected and picked up the outcome of 76 consecutive patients with symptomatic uterine fibroids who underwent embolization(n=36) or abdominal surgery(n=40)from 2003 to 2008.The mean age of two groups were 36.58±6.95 years and 38.78±8.77 years,respectively.A questionnaire and review of medical records assessed all procedure-related complications and changes in symptoms were also analyzed.Results Follow-up time for the embolization and surgery groups were 16.3±7.9 and 14.9±9.3 months,respectively.The respective observed success rates in uterine fibroid embolization and surgery patients were 76.7%versus 62.9%for menorrhagia(p＞0.05),75.0%versus 38.1%for pain(p＜0.05) and 53.3%versus 89.5%for mass effect(p＜0.05).rhe incidence rates of complications were 11.1% and 32.5%(p＜0.05).The mean hospital stay for UAE was 2.3 days shorter than that of myomectomy(p＜0.05).but the mean hospital fee of UAE was 5800 yuan more than that of myomectomy(P＜0.01).Conclusion Uterine fibroid embolization is a less invasive and more safer treatment option in women with symptomatic leiomyomas than abdominal myomectomy. In the control of clinical symptoms,UAE is as well as myomectomy,and embolization has less incidence rate of complications than myomectomy.Therefore it can be used as one of the main clinical methods for uterine fibroids.更多还原