Department of Vascular and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Maréchal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex, France.
Eur J Radiol. 2011 Jul;79(1):1-6. doi: 10.1016/j.ejrad.2009.09.028. Epub 2009 Oct 28.
To evaluate the efficacy of pre-myomectomy uterine artery embolization with gelatin sponge particles to reduce operative blood loss and facilitate removal of fibroids.
This retrospective study included 33 women (mean age, 36 years; range, 24-45 years), of whom at least 18 wished to preserve fertility. They presented with at least one large myoma (mean diameter, 90 mm; range, 50-150 mm) and had undergone preoperative uterine artery embolization with resorbable gelatin sponge by unilateral femoral approach between December 2001 and November 2008. Clinical, radiological and surgical data were available for all patients. Mean haemoglobin levels before and after surgery were compared with Student's t-test.
No complication or technical failure of embolization occurred. The myomectomies were performed during laparotomy (25 cases) or laparoscopy (8 cases). Dissection of fibroids was easier (mean, 3 per patient; range, 1-11), with a mean operating time of 108±50 min (range, 30-260 min). Bloodless surgery was the rule with a mean estimated peroperative blood loss of 147±249 mL (range, 0-800 mL). Mean pre-(12.9±1.3g/dL) and post-therapeutic (11.4±1.2g/dL) haemoglobin levels were not statistically different (p>0.05). There was no need for blood transfusion. None of the patients required hysterectomy. The mean duration of hospital stay was 7.5±1.3 days (range, 3-12 days).
Preoperative uterine artery embolization is effective in reducing intraoperative blood loss and improves the chances of performing conservative surgery. It should be considered a useful adjunct to myomectomy in women at high hemorrhagic risk or who refuse blood transfusion.
评估术前子宫肌瘤动脉栓塞术用明胶海绵颗粒减少手术出血量和便于剔除肌瘤的疗效。
这项回顾性研究包括 33 名妇女（平均年龄 36 岁；范围 24-45 岁），其中至少 18 名希望保留生育能力。她们至少有一个大肌瘤（平均直径 90 毫米；范围 50-150 毫米），并于 2001 年 12 月至 2008 年 11 月期间经单侧股动脉途径行术前子宫肌瘤动脉栓塞术，用可吸收明胶海绵。所有患者均有临床、放射学和手术资料。比较手术前后平均血红蛋白水平采用 Student's t 检验。
无栓塞并发症或技术失败。子宫肌瘤切除术在剖腹手术（25 例）或腹腔镜手术（8 例）下进行。肌瘤的解剖更容易（平均每人 3 个；范围 1-11 个），平均手术时间为 108±50 分钟（范围 30-260 分钟）。术中无出血，平均估计术中出血量为 147±249 毫升（范围 0-800 毫升）。平均术前（12.9±1.3g/dL）和治疗后（11.4±1.2g/dL）血红蛋白水平无统计学差异（p>0.05）。无需输血。无一例患者需要子宫切除术。平均住院时间为 7.5±1.3 天（范围 3-12 天）。
术前子宫肌瘤动脉栓塞术可有效减少术中出血量，并提高实施保守手术的机会。对于出血风险高或拒绝输血的妇女，它应被视为子宫肌瘤切除术的有用辅助手段。
