Szkodziak Piotr, Pyra Krzysztof, Szkodziak Filip, Krzyżanowski Jarosław, Czuczwar Piotr, Woźniak Sławomir, Jargiełło Tomasz, Paszkowski Tomasz
3rd Chair and Department of Gynecology, Medical University of Lublin;
Department of Interventional Radiology and Neuroradiology, Medical University of Lublin.
J Vis Exp. 2020 Sep 15(163). doi: 10.3791/61530.
Uterine fibroids are benign tumors originating from smooth muscle tissue, constituting uterine muscle stroma. Uterine fibroids are the most common benign tumors found in women. In 20%-50% of women, fibroids are asymptomatic and do not require any treatment. The main symptoms of uterine fibroids are profuse menstrual bleeding, abnormal uterine bleeding, and pressure symptoms. Pressure symptoms can cause pelvic pain syndrome, urination disorders, and constipation. The treatment methods that are currently used include surgical treatment, pharmacological therapy, and minimally invasive procedures. The most commonly applied minimally invasive method is the embolization of uterine arteries. This procedure is currently a widely accepted method of treatment for symptomatic uterine fibroids and has been recognized as such by the National Institute for Health and Clinical Excellence in the guidelines for heavy menstrual bleeding. This is a complicated procedure and requires close cooperation between gynecologists and interventional radiologists. We present a protocol applicable to uterine artery embolization in the treatment of symptomatic uterine fibroids. The protocol is divided into five section. The first two section are intended for gynecologists and interventional radiologists, explaining how to qualify and prepare a patient for embolization in a step-by-step manner. Section three, which is directed at interventional radiologists, explains how embolization should be done. Section four is directed at gynecologists or hospital ward doctors who look after the patients after embolization. This section of the protocol offers a method for treating post-embolization pain using the Patient Controlled Analgesia (PCA) pump. Section five completes the procedure with an assessment of the effects and late complications of uterine artery embolization. All five section create a uniform protocol directed at clinicians, experts, and researchers new to the field.
子宫肌瘤是起源于平滑肌组织的良性肿瘤，构成子宫肌层。子宫肌瘤是女性最常见的良性肿瘤。20% - 50%的女性子宫肌瘤无症状，无需任何治疗。子宫肌瘤的主要症状是月经过多、子宫异常出血和压迫症状。压迫症状可导致盆腔疼痛综合征、排尿障碍和便秘。目前使用的治疗方法包括手术治疗、药物治疗和微创手术。最常用的微创方法是子宫动脉栓塞术。该手术目前是治疗有症状子宫肌瘤的一种广泛接受的方法，并且在国家卫生与临床优化研究所关于月经过多的指南中也被认可。这是一个复杂的手术，需要妇科医生和介入放射科医生密切合作。我们提出了一种适用于子宫动脉栓塞术治疗有症状子宫肌瘤的方案。该方案分为五个部分。前两部分是针对妇科医生和介入放射科医生的，逐步解释如何对患者进行栓塞的资格评估和准备。第三部分针对介入放射科医生，解释如何进行栓塞。第四部分针对妇科医生或栓塞后照顾患者的医院病房医生。该方案的这一部分提供了一种使用患者自控镇痛（PCA）泵治疗栓塞后疼痛的方法。第五部分通过评估子宫动脉栓塞的效果和晚期并发症来完成整个过程。所有五个部分为该领域的临床医生、专家和新手研究人员创建了一个统一的方案。
