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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
Objective To analyze the related technical factors of dextran microsphere arterial embolization in treating uterine fibroids and evaluate the preliminary clinical efficacy of this technique in the treatment of 38 patients. Methods From April 1999 to January 2001, 38 patients with uterine fibroids were treated with dextran microspheres by superselective bilateral uterine artery embolization. Patients ranged in age from 2 to 48 years, with an average of 37 2 years. Clinical manifestations of menorrhagia, frequent urination, infertility and lower abdomen pain and other symptoms. Among them, there were 4 cases of subserosal fibroids, 34 cases of submucous myomas or intramural fibroids, and myomas diameter ranging from 2 to 10 9 cm. 32 cases of single myoma, 6 cases of multiple myxoma. All cases were using the right femoral artery approach, single head hunter catheter bilateral uterine artery catheterization technology. Embolization with dextran microspheres (diameter 2 2 5 - 45 0 μm) and 3-5 gelatin sponge blocks. After embolization monthly clinical and B-follow-up to observe the clinical efficacy. Results The success rate of superselective intubation and embolization was 100%. Thirty-five patients had good pain control after embolization. Follow-up in March, 36 (95%) patients improved clinical symptoms; 2 cases were ineffective, accounting for 5%. B-ultrasound follow-up showed fibroids volume decreased over time, after 6 months, 5 cases of fibroids disappear, the average volume of myoma reduced 68%. Conclusion Dextran microspheres embolization for the treatment of uterine fibroids is a minimally invasive treatment, fibroid entity can be reduced, the clinical symptoms improved. The technology is more suitable for submucosal uterine fibroids with menorrhagia in patients with clinical treatment