Dueholm Margit, Langfeldt Sten, Mafi Hossain M, Eriksen Gitte, Marinovskij Edvard
Department of Obstetrics and Gynecology, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus N, 8200, Denmark.
Department of Radiology, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus N, 8200, Denmark.
Eur J Obstet Gynecol Reprod Biol. 2014 Jul;178:100-6. doi: 10.1016/j.ejogrb.2014.04.022. Epub 2014 Apr 26.
To evaluate outcome of invasive gynecological re-interventions after uterine artery embolisation (UAE) in relation to leiomyoma characteristics.
A cohort of 114 women with symptomatic myomas underwent UAE. Myoma characteristics were determined by contrast-enhanced magnetic resonance imaging (MRI) before and 6 months after treatment. The median follow-up time after UAE was 55.9 months; (range 20-116). Data on gynecological re-interventions were obtained for all patients and were analysed using the Kaplan-Meier method. Data were obtained on frequency of invasive re-interventions: major myoma procedures (hysterectomy, re-embolisation, laparoscopic or abdominal myomectomy) and outpatient hysteroscopic myoma procedures. Myoma characteristics with impact on outcome of re-interventions were determined by statistical analysis.
Total re-intervention rate was 35.1%. Hysterectomy was performed due to myoma related symptoms in 6.1% of patients, but 23.7% of patients underwent additional uterine procedures, mainly outpatient hysteroscopy (15%). Major myoma re-intervention correlated with the extent of the infarct at follow-up MRI (n=107). Patients had undergone major re-intervention (3 years) as follows: infarct group C (<80%, n=16) 44%, infarct group B (80-99%, n=16) 19%, and infarct group A (100%, n=75) 10.1% ((p<0.01) for both A vs B+C and A+B vs C). Major re-interventions were not associated with the presence of submucous myomas; but the hazard ratio (CI 95%) for undergoing hysteroscopic re-intervention was 8.4 (2-29) (p=0.001) in patients with submucous myomas, but 12.7 (5-35) (p<0.0001) in patients with more than one submucous myomas.
Complete infarction after UAE reduces the need for major re-interventions. Assessment of complete infarction may be considered to improve quality in UAE procedures. Patients with more than one submucous myoma at UAE may often have hysteroscopic removal of residual myomas.
评估子宫动脉栓塞术（UAE）后侵入性妇科再次干预的结果与平滑肌瘤特征的关系。
114例有症状肌瘤的女性接受了UAE。在治疗前和治疗后6个月通过对比增强磁共振成像（MRI）确定肌瘤特征。UAE后的中位随访时间为55.9个月；（范围20 - 116个月）。获取了所有患者的妇科再次干预数据，并使用Kaplan - Meier方法进行分析。获取了侵入性再次干预的频率数据：主要肌瘤手术（子宫切除术、再次栓塞术、腹腔镜或开腹肌瘤切除术）和门诊宫腔镜肌瘤手术。通过统计分析确定对再次干预结果有影响的肌瘤特征。
总再次干预率为35.1%。6.1%的患者因肌瘤相关症状进行了子宫切除术，但23.7%的患者接受了额外的子宫手术，主要是门诊宫腔镜检查（15%）。主要肌瘤再次干预与随访MRI时梗死范围相关（n = 107）。患者在3年时接受主要再次干预的情况如下：梗死C组（<80%，n = 16）为44%，梗死B组（80 - 99%，n = 16）为19%，梗死A组（100%，n = 75）为10.1%（A组与B + C组以及A + B组与C组相比，p均<0.01）。主要再次干预与黏膜下肌瘤的存在无关；但黏膜下肌瘤患者接受宫腔镜再次干预的风险比（95%CI）为8.4（2 - 29）（p = 0.001），而有多个黏膜下肌瘤的患者为12.7（5 - 35）（p<0.0001）。
UAE后完全梗死减少了主要再次干预的需求。可考虑评估完全梗死情况以提高UAE手术的质量。UAE时有多个黏膜下肌瘤的患者可能经常需要通过宫腔镜切除残留肌瘤。
