Department of Obstetrics and Gynecology, General Faculty Hospital and First Medical Faculty of Charles University, Prague, Czech Republic.
Int J Womens Health. 2014 Jun 20;6:623-9. doi: 10.2147/IJWH.S43591. eCollection 2014.
Uterine artery embolization (UAE) is a minimally invasive procedure with large symptomatic potential in treatment of women with uterine leiomyomas. Due to specificities of this method and possible complications the appropriate indication is crucial. Patient' symptoms, age, plans for pregnancy, and surgical and reproductive history play a major role in decision-making regarding appropriate subjects for UAE. Close cooperation between the gynecologist and the interventional radiologist is necessary. UAE is usually offered as an alternative to surgical treatment. In patients with no fertility plans, it is a less invasive option than abdominal hysterectomy, with a comparable effect on fibroid-related symptoms and quality of life. The need for reintervention is markedly greater in patients after UAE (up to 35% within 5 years) than after hysterectomy. Women with large symptomatic fibroids wishing to retain the uterus and ineligible for minimally invasive (laparoscopic or vaginal) hysterectomy are good candidates for UAE. However, studies comparing UAE with minimally invasive hysterectomy are lacking. Use of UAE in younger women desiring pregnancy is more controversial, mainly because of the significant risk of miscarriage (as high as 64% in some studies) as well as the increased risk of other complications of pregnancy, such as preterm delivery, abnormal placentation, and post-partum hemorrhage. The risk of infertility or subfertility following UAE is unknown. Even poor candidates for myomectomy should be carefully selected for UAE after counseling about all possible adverse effects on fertility. Good prospective studies focused on fertility comparing UAE with no treatment or with myomectomy are needed but would be ethically questionable. This review summarizes the current knowledge regarding the benefits and potential risks of UAE from the point of view of the gynecologist, who should be responsible for proper indication of this treatment.
子宫动脉栓塞术 (UAE) 是一种微创治疗方法，在治疗子宫肌瘤患者方面具有很大的症状缓解潜力。由于该方法的特殊性和可能出现的并发症，适当的适应证至关重要。患者的症状、年龄、生育计划以及手术和生殖史在决定 UAE 的适宜人群方面起着重要作用。妇科医生和介入放射科医生之间的密切合作是必要的。UAE 通常作为手术治疗的替代方案。对于没有生育计划的患者，它是一种比剖腹子宫切除术创伤更小的选择，对肌瘤相关症状和生活质量具有相似的效果。与子宫切除术相比，UAE 后需要再次干预的患者明显更多（5 年内高达 35%）。希望保留子宫且不符合微创（腹腔镜或阴道）子宫切除术条件的有症状的大肌瘤患者是 UAE 的良好候选者。然而，缺乏比较 UAE 与微创子宫切除术的研究。对于希望怀孕的年轻女性，使用 UAE 更具争议性，主要是因为流产风险（在一些研究中高达 64%）以及妊娠其他并发症的风险增加，如早产、胎盘异常和产后出血。UAE 后不孕或不育的风险未知。即使是不适合进行肌瘤切除术的患者，在进行所有可能对生育产生不利影响的咨询后，也应仔细选择 UAE。需要进行良好的前瞻性研究，比较 UAE 与不治疗或肌瘤切除术对生育的影响，但从伦理角度来看，这是值得怀疑的。本文综述了从妇科医生的角度来看，UAE 的益处和潜在风险的最新知识，妇科医生应该对这种治疗方法的适当适应证负责。
