Tropeano Giovanna, Amoroso Sonia, Scambia Giovanni
Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy.
Hum Reprod Update. 2008 May-Jun;14(3):259-74. doi: 10.1093/humupd/dmn006. Epub 2008 Mar 14.
Efforts to develop alternatives to surgery for management of symptomatic uterine fibroids have provided new techniques and new medications. This review summarizes the existing literature on uterine artery embolization (UAE) and investigational studies on four newer approaches.
PubMed, Cochrane and Embase were searched up to December 2007. Studies reporting side-effects and complications and presenting numerical data on at least one outcome measure were included.
Case studies report 50-60% reduction in fibroid size and 85-95% relief of symptoms following UAE. The largest of these studies reported an in-hospital complication rate of 2.7% (90 of 3041 patients) and a post-discharge complication rate of 26% (710 of 2729 patients). Eight studies compared UAE with conventional surgery. Best evidence suggested that UAE offered shorter hospital stays (1-2 days UAE versus 5-5.8 days surgery, 3 randomized controlled trials (RCTs)) and recovery times (9.5-28 days UAE versus 36.2-63 days surgery, 3 RCTs) and similar major complication rates (2-15% UAE versus 2.7-20% surgery, 3 RCTs). Four studies analysing cost-effectiveness found UAE more cost-effective than surgery. There is insufficient evidence regarding fertility and pregnancy outcome after UAE. Five feasibility studies after transvaginal temporary uterine artery occlusion in 75 women showed a 40-50% reduction in fibroid volume and two early studies using magnetic resonance guided-focused ultrasound showed symptom relief at 6 months in 71% of 109 women. Two small RCTs assessing mifepristone and asoprisnil showed promising results.
Good quality evidence supports the safety and effectiveness of UAE for women with symptomatic fibroids. The current available data are insufficient to routinely offer UAE to women who wish to preserve or enhance their fertility. Newer treatments are still investigational.
为开发有症状子宫肌瘤的手术替代治疗方法所做的努力带来了新技术和新药物。本综述总结了关于子宫动脉栓塞术（UAE）的现有文献以及四种新方法的研究情况。
检索截至2007年12月的PubMed、Cochrane和Embase数据库。纳入报告副作用和并发症并呈现至少一项结局指标数值数据的研究。
病例研究报告UAE后肌瘤大小减少50% - 60%，症状缓解85% - 95%。其中最大规模的研究报告住院并发症发生率为2.7%（3041例患者中的90例），出院后并发症发生率为26%（2729例患者中的710例）。八项研究比较了UAE与传统手术。最佳证据表明，UAE住院时间更短（UAE为1 - 2天，手术为5 - 5.8天，3项随机对照试验（RCT））、恢复时间更短（UAE为9.5 - 28天，手术为36.2 - 63天，3项RCT）且主要并发症发生率相似（UAE为2% - 15%，手术为2.7% - 20%，3项RCT）。四项分析成本效益的研究发现UAE比手术更具成本效益。关于UAE后的生育能力和妊娠结局，证据不足。75名女性经阴道临时子宫动脉闭塞后的五项可行性研究显示肌瘤体积减少40% - 50%，两项使用磁共振引导聚焦超声的早期研究显示109名女性中有71%在6个月时症状缓解。两项评估米非司酮和阿索普瑞诺的小型RCT显示出有前景的结果。
高质量证据支持UAE对有症状肌瘤女性的安全性和有效性。目前现有数据不足以常规地为希望保留或提高生育能力的女性提供UAE。新的治疗方法仍在研究中。
