Czuczwar P, Wozniak S, Szkodziak P, Milart P, Wozniakowska E, Wrona W, Paszkowski T
3rd Chair and Department of Gynecology, Medical University of Lublin, Lublin, Poland.
Ultrasound Obstet Gynecol. 2015 Jun;45(6):744-50. doi: 10.1002/uog.14668. Epub 2015 May 11.
To compare the effects of two alternative treatment options for uterine fibroids, ulipristal acetate (UPA) and uterine artery embolization (UAE), on fibroid volume and vascularity at 3-month follow-up.
Premenopausal patients with symptomatic, intramural uterine fibroids were included in this prospective case-control study. Seventeen patients who qualified for preoperative UPA treatment were pair-matched with patients of similar age (± 5 years) and fibroid volume (± 10% of volume) who qualified for UAE. Patients undergoing UPA treatment received 5 mg/24 h of oral UPA for 3 months. UAE was performed in patients bilaterally by an interventional radiologist. To estimate dominant fibroid volume, Virtual Organ Computer-aided AnaLysis (VOCAL™) was used. The VOCAL program was also used to calculate three-dimensional power Doppler vascular indices: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Dominant fibroid volumes and VI, FI and VFI values were assessed before commencement of UPA treatment or UAE procedure and again at 3 months afterwards.
In both the UPA and UAE groups, fibroid volumes decreased significantly after treatment in comparison with baseline volumes obtained prior to treatment. The percentage of fibroid volume reduction after 3 months of UPA therapy (48.1%) was not significantly different from the reduction seen 3 months after the UAE procedure (47.3%). All vascular indices decreased significantly after treatment by UPA or UAE. The percentage reduction in VI and VFI 3 months after UAE (95.4% for both) was significantly greater than the percentage reduction in patients after 3 months of UPA therapy (51.5% and 62.5%, respectively); however the difference in FI reduction between treatment groups did not reach significance (54.3% for UAE and 30.9% for UPA). No significant side-effects were observed in either treatment group.
Fibroid treatment by UPA therapy results in a decrease in fibroid volume, comparable with that after UAE, and decreases fibroid vascularization, although to a lesser extent than does UAE.
比较两种治疗子宫肌瘤的替代方案——醋酸乌利司他（UPA）和子宫动脉栓塞术（UAE）——在3个月随访时对肌瘤体积和血管生成的影响。
有症状的壁间子宫肌瘤的绝经前患者被纳入这项前瞻性病例对照研究。17名符合术前UPA治疗条件的患者与年龄相似（±5岁）且肌瘤体积相似（±体积的10%）、符合UAE治疗条件的患者进行配对。接受UPA治疗的患者口服5mg/24小时的UPA，持续3个月。UAE由介入放射科医生对患者双侧进行。为估计主要肌瘤体积，使用了虚拟器官计算机辅助分析（VOCAL™）。VOCAL程序还用于计算三维能量多普勒血管指数：血管化指数（VI）、血流指数（FI）和血管化血流指数（VFI）。在开始UPA治疗或UAE手术前以及术后3个月再次评估主要肌瘤体积以及VI、FI和VFI值。
在UPA组和UAE组中，与治疗前获得的基线体积相比，治疗后肌瘤体积均显著减小。UPA治疗3个月后肌瘤体积减少的百分比（48.1%）与UAE手术后3个月观察到的减少百分比（47.3%）无显著差异。UPA或UAE治疗后所有血管指数均显著降低。UAE术后3个月VI和VFI的降低百分比（均为95.4%）显著高于UPA治疗3个月后患者的降低百分比（分别为51.5%和62.5%）；然而，治疗组之间FI降低的差异未达到显著水平（UAE为54.3%，UPA为30.9%）。两个治疗组均未观察到显著的副作用。
UPA治疗子宫肌瘤导致肌瘤体积减小，与UAE术后相当，并且减少肌瘤血管生成，尽管程度小于UAE。
