Ahmad Iftikhar, Ray Charles E, Conyers Carolyn
Department of Radiology, Indiana University Medical Center, University Hospital, Room 0279, 550 North University Boulevard, Indianapolis, Indiana 46202-5253, USA.
J Clin Ultrasound. 2003 Oct;31(8):401-6. doi: 10.1002/jcu.10197.
The aim of this prospective study was to describe the appearance of thrombosed uterine arteries on transvaginal sonography performed after uterine artery embolization (UAE) and to assess the prognostic value of the "white snake" sign with regard to symptomatic outcome at 12 months.
Patients who underwent UAE from January 1, 1999, to July 31, 2000, for the treatment of symptomatic leiomyomas were included in the study. Transvaginal sonography was performed before and at 3, 6, and 12 months after UAE. Patients graded the severity of their symptoms on a scale from 1 to 5, with 1 being the least and 5 the most severe, before and at 12 months after the procedure. The Wilcoxon rank-sum test was used to determine correlations between severity of symptoms and presence of the white snake sign; a p value of less than 0.05 was considered significant.
During the study period, UAE was performed in 19 patients with a mean age of 41 years (range, 32-48 years). UAE was technically successful in all patients. Eighteen patients (95%) reported symptomatic improvement at 12 months: 8 patients (42%) by 4 severity-scale points, 5(26%) by 3 points, and 5 (26%) by 2 points. The 1 patient who did not experience improvement had undergone a hysterectomy at 4 months after the UAE. At the 3-month follow-up, transvaginal sonography demonstrated a tortuous echogenic structure in the adnexa (the white snake sign) in all patients; the finding was still apparent in 10 patients at 6 months but in only 2 patients at 12 months. A direct correlation was found between persistence of the white snake sign and the degree of symptomatic improvement at 6 months (p=0.04) but not at 12 months (p=0.08).
After UAE, a thrombosed uterine artery appears on transvaginal sonography as an echogenic tortuous structure in the adnexa. Persistence of this white snake sign at 6 months after UAE may suggest a more favorable symptomatic outcome.
本前瞻性研究旨在描述子宫动脉栓塞术（UAE）后经阴道超声检查时血栓形成的子宫动脉的表现，并评估“白蛇”征对12个月时症状性结局的预后价值。
纳入1999年1月1日至2000年7月31日因症状性平滑肌瘤接受UAE治疗的患者。在UAE前以及术后3、6和12个月进行经阴道超声检查。患者在术前和术后12个月按1至5级对症状严重程度进行评分，1分为最轻，5分为最重。采用Wilcoxon秩和检验确定症状严重程度与白蛇征的存在之间的相关性；p值小于0.05被认为具有统计学意义。
在研究期间，对19例平均年龄41岁（范围32 - 48岁）的患者实施了UAE。所有患者手术技术均成功。18例患者（95%）在12个月时报告症状改善：8例患者（42%）症状严重程度评分降低4分，5例（26%）降低3分，5例（26%）降低2分。1例未改善的患者在UAE后4个月接受了子宫切除术。在3个月随访时，经阴道超声检查显示所有患者附件区有迂曲的强回声结构（白蛇征）；6个月时10例患者仍有此表现，但12个月时仅2例患者有此表现。发现白蛇征的持续存在与6个月时症状改善程度直接相关（p = 0.04），但与12个月时无关（p = 0.08）。
UAE后，经阴道超声检查显示血栓形成的子宫动脉在附件区表现为强回声迂曲结构。UAE后6个月白蛇征持续存在可能提示症状性结局更有利。
