Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Department of Integrated Traditional Chinese and Western Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Cardiovasc Intervent Radiol. 2024 Jul;47(7):901-909. doi: 10.1007/s00270-024-03700-5. Epub 2024 Mar 25.
To evaluate the safety and clinical outcome of two-session catheter-directed sclerotherapy (CDS) with 99% ethanol in patients with endometrioma.
This prospective study was approved by the institutional review board with written informed consent obtained from all participants and was registered on clinicaltrial.gov. Consecutive patients with ovarian endometrioma between June 2020 and March 2023 were prospectively evaluated for two sessions of CDS. After successful transvaginal ultrasound-guided puncture of the endometrioma, the biopsy needle was exchanged for a 7- or 8.5-F catheter for aspiration and ethanol injection. The catheter was retained in situ for a second session the next day. Endometrioma volume was measured on ultrasound before and 1, 3, and 6 months after CDS, and volume reduction ratio (VRR) was calculated. Serum anti-Müllerian hormone (AMH) was measured before and 6 months after CDS to assess ovarian reserve.
Thirty-one endometriomas in 22 patients (mean age, 31.0 years; range, 19-44 years) were treated; 28 endometriomas were successfully treated with two-session CDS, while one session was incomplete in three endometriomas in three patients due to contrast medium leakage or pain. Minor procedure-related complications developed in four patients and resolved spontaneously before discharge on the same day of the second session. No recurrence was identified during follow-up. At the 6-month follow-up, the mean endometrioma diameter decreased from 5.5 ± 1.7 to 1.4 ± 0.9 cm (P < 0.001), and the serum AMH level was lowered without statistical significance (1.37 ± 0.96 ng/mL vs. 1.18 ± 0.92 ng/mL; P = 0.170). VRRs at 1, 3, and 6 months after CDS were 84.3 ± 13.7%, 94.3 ± 5.8%, and 96.4 ± 4.7%, respectively.
Two-session CDS with 99% ethanol is safe, feasible, and effective for treating endometrioma with the ovarian function well preserved.
评估在子宫内膜异位症患者中进行两次 99%乙醇导管内硬化治疗（CDS）的安全性和临床结局。
本前瞻性研究获得了机构审查委员会的批准，并获得了所有参与者的书面知情同意，已在 clinicaltrial.gov 上注册。连续纳入 2020 年 6 月至 2023 年 3 月间患有卵巢子宫内膜异位症的患者，进行两次 CDS 治疗。经阴道超声引导下成功穿刺子宫内膜异位瘤后，将活检针换为 7 或 8.5-F 导管进行抽吸和乙醇注射。第二天原位保留导管进行第二次治疗。在 CDS 治疗前、治疗后 1、3 和 6 个月，通过超声测量子宫内膜异位瘤体积，并计算体积减少率（VRR）。在 CDS 治疗前和治疗后 6 个月测量血清抗苗勒管激素（AMH）以评估卵巢储备功能。
22 名患者的 31 个子宫内膜异位瘤（平均年龄 31.0 岁；范围 19-44 岁）接受了治疗；28 个子宫内膜异位瘤成功完成了两次 CDS 治疗，而在 3 名患者的 3 个子宫内膜异位瘤中，由于对比剂渗漏或疼痛，一次治疗未完成。4 名患者出现轻微与操作相关的并发症，在第二次治疗当天出院前自行缓解。在随访期间未发现复发。在 6 个月的随访时，平均子宫内膜异位瘤直径从 5.5±1.7cm 减小至 1.4±0.9cm（P<0.001），血清 AMH 水平降低但无统计学意义（1.37±0.96ng/mL 比 1.18±0.92ng/mL；P=0.170）。CDS 治疗后 1、3 和 6 个月的 VRR 分别为 84.3±13.7%、94.3±5.8%和 96.4±4.7%。
两次 99%乙醇 CDS 治疗子宫内膜异位症是安全、可行且有效的，同时卵巢功能得到很好的保留。
