Czuczwar Piotr, Woźniak Sławomir, Szkodziak Piotr, Woźniakowska Ewa, Paszkowski Maciej, Wrona Wojciech, Milart Paweł, Paszkowski Tomasz, Popajewski Michał
3 Chair and Department of Gynecology, Medical University of Lublin, Poland.
Prz Menopauzalny. 2014 Sep;13(4):247-52. doi: 10.5114/pm.2014.45001. Epub 2014 Sep 9.
Uterine artery embolization (UAE) is a minimally invasive treatment option for symptomatic fibroids. Long-term follow-up studies have shown that at five-year follow-up after UAE, up to 30% of patients required a hysterectomy. Therefore, it seems of utmost importance to identify patients, who are unlikely to benefit from UAE. It has been postulated that the percentage volume reduction of fibroids may predict long-term UAE outcome. The results of available studies are equivocal, therefore it seemed of interest to investigate the correlation between the preinterventional intramural fibroid volume and imaging outcome of UAE in premenopausal patients.
Uterine artery embolization was performed in 65 premenopausal patients with symptomatic, intramural fibroids. Dominant fibroid volume was assessed using an integrated VOCAL (Virtual Organ Computer-aided AnaLysis) imaging program at baseline and 3 months after UAE. The percentage reduction of fibroid volume was calculated. The association between preinterventional fibroid volumes and percentage volume reductions was determined with the Spearman rank correlation test.
Before UAE, the median dominant fibroid volume was 101 cm(3) (range 23.6-610). At three-month follow-up the median dominant leiomyoma volume decreased to 50.4 cm(3) (range 6.9-193.9). Median percentage reduction of fibroid volume three months after UAE was calculated at 50.1% (range 2.7-93.5). The Spearman correlation test between the preinterventional dominant fibroid volume and percentage volume reduction showed a statistically significant, positive correlation (R = 0.33; p = 0.006).
The percentage volume reduction of intramural leiomyomas after UAE seems to be more pronounced in the case of larger tumors.
子宫动脉栓塞术（UAE）是有症状子宫肌瘤的一种微创治疗选择。长期随访研究表明，UAE术后五年随访时，高达30%的患者需要行子宫切除术。因此，识别不太可能从UAE中获益的患者似乎极为重要。据推测，肌瘤体积缩小百分比可能预测UAE的长期疗效。现有研究结果并不明确，因此，研究绝经前患者介入治疗前壁间肌瘤体积与UAE影像结果之间的相关性似乎很有意义。
对65例有症状的绝经前壁间肌瘤患者实施子宫动脉栓塞术。在基线和UAE术后3个月，使用集成的VOCAL（虚拟器官计算机辅助分析）成像程序评估主要肌瘤体积。计算肌瘤体积缩小百分比。采用Spearman等级相关检验确定介入治疗前肌瘤体积与体积缩小百分比之间的关联。
UAE术前，主要肌瘤体积中位数为101 cm³（范围23.6 - 610）。在3个月随访时，主要平滑肌瘤体积中位数降至50.4 cm³（范围6.9 - 193.9）。UAE术后3个月肌瘤体积缩小百分比中位数计算为50.1%（范围2.7 - 93.5）。介入治疗前主要肌瘤体积与体积缩小百分比之间的Spearman相关性检验显示存在统计学显著的正相关（R = 0.33；p = 0.006）。
UAE术后壁间平滑肌瘤体积缩小百分比在较大肿瘤的情况下似乎更为明显。
