Bai Sang Wook, Jang Jin Beum, Lee Do Yun, Jeong Kyung Ah, Kim Sei Kwang, Park Ki Hyun
Department of Obstetrics and Gynecology, Yonsei University College of Medicine, C.P.O. Box 8044, Seoul 120-752, Korea.
Yonsei Med J. 2002 Jun;43(3):346-50. doi: 10.3349/ymj.2002.43.3.346.
The purpose of this study was to establish guidelines for using uterine artery embolization for the treatment of uterine leiomyomas accompanied by adenomyosis in Korea. This study was performed to investigate 1) the effects of uterine embolization on leiomyoma accompanied by adenomyosis, 2) the outcome of uterine embolization according to the embolization materials used, 3) the relationship between the Resistance Index (RI) and the change in uterine volume.
We performed a retrospective study on 37 women who had uterine leiomyomas accompanied by adenomyosis. Bilateral uterine artery embolization was performed over a period of 17 months in 37 patients (age range 25 - 65) experiencing pain, hypermenorrhea, urinary frequency, etc. due to leiomyomas. Ultrasound imaging was performed before the procedure and at mean 6.9 months after the procedure.
All procedures were technically successful. Mean clinical follow-up time was 12.8 months. Minor complications occurred in 82% patients following the procedure. After follow-up imaging, the median uterine volume decreased by 34.4% and the dominant myoma volume decreased by 86%. There was no statistical difference in the uterine volume reduction and the dominant myoma size reduction, whether the occluding agent was polyvinyl alcohol, polyvinyl alcohol plus gelfoam, or gelfoam, and whether the ultrasound measured Resistance Index value before the procedure was low or high.
Primary candidates for uterine artery embolization include those with symptomatic uterine leiomyomas, who no longer desire fertility, but who wish to avoid surgery or are poor surgical risks. According to the results of our study, adenomyosis should not be considered as a contraindication for uterine artery embolization. However, because little data is available about the subsequent reproductive potential following this procedure, it should not be routinely advocated for infertile women. Further investigation is warranted regarding the choice of occluding agent and the role of the Resistance Index.
本研究旨在制定韩国使用子宫动脉栓塞术治疗伴有子宫腺肌病的子宫肌瘤的指南。本研究旨在调查：1）子宫栓塞术对伴有子宫腺肌病的子宫肌瘤的影响；2）根据所用栓塞材料不同，子宫栓塞术的效果；3）阻力指数（RI）与子宫体积变化之间的关系。
我们对37例伴有子宫腺肌病的子宫肌瘤女性患者进行了一项回顾性研究。在17个月的时间里，对37例（年龄范围25 - 65岁）因子宫肌瘤出现疼痛、月经过多、尿频等症状的患者实施了双侧子宫动脉栓塞术。术前及术后平均6.9个月进行超声检查。
所有手术在技术上均获成功。平均临床随访时间为12.8个月。术后82%的患者出现轻微并发症。随访成像后，子宫体积中位数减少了34.4%，主要肌瘤体积减少了86%。无论闭塞剂是聚乙烯醇、聚乙烯醇加明胶海绵还是明胶海绵，以及术前超声测量的阻力指数值是高还是低，子宫体积缩小和主要肌瘤大小缩小方面均无统计学差异。
子宫动脉栓塞术的主要适用人群包括有症状的子宫肌瘤患者，这些患者不再渴望生育，但希望避免手术或手术风险较高。根据我们的研究结果，子宫腺肌病不应被视为子宫动脉栓塞术的禁忌证。然而，由于关于该手术后后续生育潜力的数据较少，不应常规推荐给不孕女性。关于闭塞剂的选择和阻力指数的作用，有必要进行进一步研究。
