Department of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Brauerstr. 15, 8401, Winterthur, Switzerland.
Department of Obstetrics and Gynecology, Cantonal Hospital Winterthur, Brauerstr. 15, 8401, Winterthur, Switzerland.
Cardiovasc Intervent Radiol. 2020 Feb;43(2):231-237. doi: 10.1007/s00270-019-02305-7. Epub 2019 Sep 17.
To assess the detectability and frequency of the different types of utero-ovarian anastomosis, the correlation between type of anastomosis and ovarian failure after UAE, as well as the impact of coiling as a strategy for the prevention of ovarian failure.
We retrospectively studied a population of 92 women treated with uterine artery embolization at our institution between 2007 and 2017. Utero-ovarian anastomoses were categorized on angiographic sequences by two radiologists based on the classification published by Razavi et al. (Radiology 224(3):707-712, 2002), and Cohen's kappa was calculated. Ovarian failure was defined as an increase in serum FSH above 27 mIU/ml three months after embolization.
Out of a total of 184 anastomoses, 27% were classified as type Ia, 45% as type Ib, 1% as type II and 24% as type III. Three percent of anastomoses could not be determined. There was very good inter-observer reliability on the classification of utero-ovarian anastomoses (κ = 0.847). Ovarian failure occurred in six out of 92 women (7%). Each had at least one type Ib (n = 4) or type III (n = 1) anastomosis, with the exception of one patient in whom the type of anastomosis could not be determined. All women presenting with ovarian failure were 45 years of age or older. No patient with protective coiling developed ovarian failure.
Utero-ovarian anastomoses are more common than previously expected and can be reliably classified with very good inter-observer reliability. Patients with type Ib and type III anastomoses carry the risk of ovarian failure after uterine artery embolization. Protective coiling seems to be an adequate strategy for avoiding ovarian failure in those types of anastomoses.
评估不同类型子宫卵巢吻合术的可检测性和频率、吻合术类型与 UAE 后卵巢功能衰竭之间的相关性，以及作为预防卵巢功能衰竭的策略的线圈缠绕的影响。
我们回顾性研究了 2007 年至 2017 年期间在我院接受子宫动脉栓塞治疗的 92 名女性患者的人群。两位放射科医生根据 Razavi 等人发表的分类标准（Radiology 224(3):707-712, 2002），通过血管造影序列对子宫卵巢吻合术进行分类，并计算 Cohen's kappa。卵巢功能衰竭定义为栓塞后三个月血清 FSH 升高超过 27 mIU/ml。
总共 184 个吻合术中，27%归类为 Ia 型，45%归类为 Ib 型，1%归类为 II 型，24%归类为 III 型。3%的吻合术无法确定。子宫卵巢吻合术的分类具有非常好的观察者间可靠性（κ=0.847）。92 名女性中有 6 名（7%）发生卵巢功能衰竭。每位患者至少有一种 Ib 型（n=4）或 III 型（n=1）吻合术，除了一名无法确定吻合术类型的患者。所有发生卵巢功能衰竭的患者年龄均为 45 岁或以上。无保护线圈缠绕的患者发生卵巢功能衰竭。
子宫卵巢吻合术比预期更为常见，且具有非常好的观察者间可靠性，可以可靠地进行分类。Ib 型和 III 型吻合术的患者在接受子宫动脉栓塞后有发生卵巢功能衰竭的风险。对于这些类型的吻合术，保护线圈缠绕似乎是避免卵巢功能衰竭的一种充分策略。
