卵巢动脉栓塞对子宫疾病介入治疗的意义
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摘要
子宫动脉栓塞术(UAE)或髂内动脉栓塞术(IIAE)具有安全有效、微创、能够保留子宫及生育功能等优点,近年来已成为子宫疾病治疗的一线方法。卵巢动脉(OA)参与子宫病变供血发生率高,是单纯UAE或IIAE治疗后子宫肌瘤复发或再次子宫出血的原因之一。子宫疾病介入手术中发现OA参与病变供血,UAE联合卵巢动脉栓塞术(OAE)是有意义的,不会增加卵巢功能衰竭发生率,但需要大样本前瞻性对照研究证明具体意义。为避免卵巢功能衰竭,OAE术时应尽可能作单侧栓塞和远端栓塞。
Both uterine artery embolization(UAE) and internal iliac artery embolization(IIAE) have the advantages of reliable safety, high effectiveness, minimal invasion, and effective preservation of uterine and reproductive functions, etc. In recent years, UAE and IIAE have become a first-line treatment for the uterine diseases. The incidence of ovarian artery(OA) participating in the blood supply of uterine lesions is very high, which is one of the causes of uterine leiomyoma recurrence and recurrent uterine bleeding after UAE or IIAE treatment. If OA is found to be involved in the blood supply of uterine lesions during interventional procedure, UAE combined with ovarian artery embolization(OAE) is a valuable therapy,which, as far as current clinical knowledge is concerned, will not increase the incidence of ovarian failure,although prospective controlled studies with large sample are needed to prove this view. In order to avoid ovarian failure, unilateral embolization and distal embolization should be performed as far as possible during OAE.(J Intervent Radiol, 2019, 28: 692-695)
Both uterine artery embolization(UAE) and internal iliac artery embolization(IIAE) have the advantages of reliable safety, high effectiveness, minimal invasion, and effective preservation of uterine and reproductive functions, etc. In recent years, UAE and IIAE have become a first-line treatment for the uterine diseases. The incidence of ovarian artery(OA) participating in the blood supply of uterine lesions is very high, which is one of the causes of uterine leiomyoma recurrence and recurrent uterine bleeding after UAE or IIAE treatment. If OA is found to be involved in the blood supply of uterine lesions during interventional procedure, UAE combined with ovarian artery embolization(OAE) is a valuable therapy,which, as far as current clinical knowledge is concerned, will not increase the incidence of ovarian failure,although prospective controlled studies with large sample are needed to prove this view. In order to avoid ovarian failure, unilateral embolization and distal embolization should be performed as far as possible during OAE.(J Intervent Radiol, 2019, 28: 692-695)
引文
[1]Spies JB.Current role of uterine artery embolization in the management of uterine fibroids[J].Clin Obstet Gynecol,2016,59:93-102.
[2]唐世伟,陈俊,王忠敏,等.介入栓塞术对比手术治疗有症状子宫肌瘤安全性及有效性的meta分析[J].介入放射学杂志,2015,24:200-205.
[3]Scheurig-Muenkler C,Koesters C,Grieser C,et al.Treatment failure after uterine artery embolization:prospective cohort study with multifactorial analysis of possible predictors of long-term outcome[J].Eur J Radiol,2012,81:E727-E731.
[4]Kim JE,So YH,Kim BJ,et al.Postpartum hemorrhage from non-uterine arteries:clinical importance of their detection and the results of selective embolization[J].Acta radiol,2018,59:932-938.
[5]王茂强,刘凤永,段峰,等.卵巢动脉参与盆腔病变供血的介入诊疗研究[J].中华放射学杂志,2006,40:1190-1194.
[6]Lanciego C,Diaz-Plaza I,Ciampi JJ,et al.Utero-ovarian anastomoses and their influence on uterine fibroid embolization[J].J Vasc Interv Radiol,2012,23:595-601.
[7]Witt MC,Bollwein H,Probst J,et al.Doppler sonography of the uterine and ovarian arteries during a superovulatory program in horses[J].Theriogenology,2012,77:1406-1414.
[8]刘晓宇,欧阳振波.卵巢动脉对子宫肌瘤动脉栓塞疗效及预后的影响[J].介入放射学杂志,2014,23:929-932.
[9]王亚光,吕维富,李兵.子宫肌瘤子宫动脉栓塞术中瘤体与卵巢血供的相关性及临床观察[J].介入放射学杂志,2015,24:206-209.
[10]王茂强,陈凯,段峰,等.盆腔出血性疾病卵巢动脉栓塞治疗[J].介入放射学杂志,2007,16:606-610.
[11]金龙,段峰,王茂强.卵巢动脉栓塞术的研究进展及临床意义[J].中国介入影像与治疗学,2015,12:407-409.
[12]Bradley LD.Uterine fibroid embolization:a viable alternative to hysterectomy[J].Am J Obstet Gynecol,2009,201:127-135.
[13]赵振华,王挺,卢增新,等.子宫动脉栓塞治疗单发和多发子宫肌瘤远期疗效对比分析[J].介入放射学杂志,2013,22:557-561.
[14]Ruuskanen A,Hippelainen M,Sipola P,et al.Uterine artery embolization versus hysterctomy for leiomyomas:primary and 2year follow-up results of a randomised prospective clinical trial[J].Eur Radiol,2010,20:2524-2532.
[15]赵振华,王挺,王伯胤,等.子宫动脉栓塞治疗子宫肌瘤的远期疗效分析[J].中华妇产科杂志,2012,47:857-859.
[16]Scheurig-Muenkler C,Poellinger A,Wagner M,et al.Ovarian artery embolization in patients with collateral supply to symptomatic uterine leiomyomata[J].Cardiovasc Intervent Radiol,2011,34:1199-1207.
[17]张宇慧,周顺科.子宫肌瘤介入治疗近展[J].介入放射学杂志,2013,22:340-345.
[18]Razavi MK,Wolanske KA,Hwang GL,et al.Angiographic classification of ovarian artery-to-uterine artery anastomoes:initial observations in utrine fibroid embolization[J].Radiology,2002,224:707-712.
[19]Kim HS,Tsai J,Patra A,et al.Effects of utero-ovarian anastomoses on clinical outcomes and repeat intervention rates after uterine artery embolization[J].J Vasc Interv Radiol,2006,17:783-789.
[20]Scheurig-Muenkler C,Poellinger A,Wagner M,et al.Ovarian artery embolization in patients with collateral supply to symptomatic uterine leiomyomata[J].Cardiovasc Intervent Radiol,2011,34:1199-1207.
[21]Hu NN,Kaw D,McCullough MF,et al.Menopause and menopausal symptoms after ovarian artery embolization:a comparison with uterine artery embolization controls[J].J Vasc Interv Radiol,2011,22:710-715.
[22]Salazar GM,Gregory Walker T,Gonway RF,et al.Embolization of angiographically visible typeⅠandⅡutero-ovarian anastomoses during uterine artery emboization for fibroid tumors:impact on symptom recurrence and permanent amenorrhea[J].J Vasc Interv Radiol,2013,24:1347-1352.
[23]Campbell J,Rajan DK,Kachura JR,et al.Efficacy of ovarian artery embolization for uterine fibroids:clinical and magnetic resonance imaging evaluations[J].Can Assoc Radiol J,2015,66:164-170.
[24]Kwon JH,Kim MD,Lee KH,et al.Abrrant ovarian collateral originating from external iliac artery during uterine artery embolization[J].Cardiovasc Intervent Radiol,2013,15:243-245.
[25]Smoger DL,Kancherla V,Shlansky-Goldberg RD.Uterine fundal blood supply from an aberrant left ovarian artery originating from the inferior mesenteric artery:implications for uterine artery embolization[J].J Vasc Interv Radiol,2010,21:941-944.
[26]刘正玲,郝长宏,许宗兰.栓塞子宫动脉及供应子宫肌瘤的卵巢动脉治疗子宫肌瘤前瞻性研究[J].介入放射学杂志,2016,25:598-601.
[27]Lee HY,Shin JH,Kim J,et al.Primary postpartum hemorrhage:outcome of pelvic arterial embolization in 251 patients at a single institution[J].Radiology,2012,264:903-909.
[28]汤萍萍,胡惠英,高劲松,等.盆腔动脉栓塞术治疗原发性产后出血的效果及安全性分析[J].中华妇产科杂志,2016,51:81-86.
[29]Wang MQ,Liu FY,Duan F,et al.Ovarian artery embolization supplementing hypogastric-uterine artery embolization for control of severe postpartum hemorrhage:report of eight cases[J].JVasc Interv Radiol,2009,20:971-976.
[30]Cheong JY,Kong TW,Son JH,et al.Outcome of pelvic arterial embolization for postpartum hemorrhage:a retrospective review of 117 cases[J].Obstet Gynecol Sci,2014,57:17-27.
[31]吴普照,张跃伟,赵广生,等.介入栓塞宫颈癌出血伴异位卵巢动脉供血并左髂内动脉缺如一例[J].介入放射学杂志,2014,23:230-231.
[32]赵海,姜峰,张继军,等.针对产后大出血介入治疗时卵巢供血支是否需要栓塞的探究[J].新疆医学,2017,47:184-186.
[33]王春岩,庞桦进,王江云,等.卵巢动脉供血对子宫动脉栓塞术止血效果的影响[J].中国介入影像与治疗学,2015,12:143-146.
[34]Ouyang Z,Liu P,Yu Y,et al.Role of ovarian artery to uterine artery anastomoses in uterine artery embolization:intial anatomic and radiologic studies[J].Surg Radiol Anat,2012,34:737-741.
[35]何俊峰,闫国珍,穆永旭,等.彩色多普勒血流成像在检测子宫动脉栓塞术前后卵巢血流变化中的应用[J].中国医学影像学杂志,2012,20:138-140.
[36]万九峰,董永安,姬超,等.介入栓塞治疗难治性产后出血的临床分析[J].中国医刊,2015,50:82-85.
[2]唐世伟,陈俊,王忠敏,等.介入栓塞术对比手术治疗有症状子宫肌瘤安全性及有效性的meta分析[J].介入放射学杂志,2015,24:200-205.
[3]Scheurig-Muenkler C,Koesters C,Grieser C,et al.Treatment failure after uterine artery embolization:prospective cohort study with multifactorial analysis of possible predictors of long-term outcome[J].Eur J Radiol,2012,81:E727-E731.
[4]Kim JE,So YH,Kim BJ,et al.Postpartum hemorrhage from non-uterine arteries:clinical importance of their detection and the results of selective embolization[J].Acta radiol,2018,59:932-938.
[5]王茂强,刘凤永,段峰,等.卵巢动脉参与盆腔病变供血的介入诊疗研究[J].中华放射学杂志,2006,40:1190-1194.
[6]Lanciego C,Diaz-Plaza I,Ciampi JJ,et al.Utero-ovarian anastomoses and their influence on uterine fibroid embolization[J].J Vasc Interv Radiol,2012,23:595-601.
[7]Witt MC,Bollwein H,Probst J,et al.Doppler sonography of the uterine and ovarian arteries during a superovulatory program in horses[J].Theriogenology,2012,77:1406-1414.
[8]刘晓宇,欧阳振波.卵巢动脉对子宫肌瘤动脉栓塞疗效及预后的影响[J].介入放射学杂志,2014,23:929-932.
[9]王亚光,吕维富,李兵.子宫肌瘤子宫动脉栓塞术中瘤体与卵巢血供的相关性及临床观察[J].介入放射学杂志,2015,24:206-209.
[10]王茂强,陈凯,段峰,等.盆腔出血性疾病卵巢动脉栓塞治疗[J].介入放射学杂志,2007,16:606-610.
[11]金龙,段峰,王茂强.卵巢动脉栓塞术的研究进展及临床意义[J].中国介入影像与治疗学,2015,12:407-409.
[12]Bradley LD.Uterine fibroid embolization:a viable alternative to hysterectomy[J].Am J Obstet Gynecol,2009,201:127-135.
[13]赵振华,王挺,卢增新,等.子宫动脉栓塞治疗单发和多发子宫肌瘤远期疗效对比分析[J].介入放射学杂志,2013,22:557-561.
[14]Ruuskanen A,Hippelainen M,Sipola P,et al.Uterine artery embolization versus hysterctomy for leiomyomas:primary and 2year follow-up results of a randomised prospective clinical trial[J].Eur Radiol,2010,20:2524-2532.
[15]赵振华,王挺,王伯胤,等.子宫动脉栓塞治疗子宫肌瘤的远期疗效分析[J].中华妇产科杂志,2012,47:857-859.
[16]Scheurig-Muenkler C,Poellinger A,Wagner M,et al.Ovarian artery embolization in patients with collateral supply to symptomatic uterine leiomyomata[J].Cardiovasc Intervent Radiol,2011,34:1199-1207.
[17]张宇慧,周顺科.子宫肌瘤介入治疗近展[J].介入放射学杂志,2013,22:340-345.
[18]Razavi MK,Wolanske KA,Hwang GL,et al.Angiographic classification of ovarian artery-to-uterine artery anastomoes:initial observations in utrine fibroid embolization[J].Radiology,2002,224:707-712.
[19]Kim HS,Tsai J,Patra A,et al.Effects of utero-ovarian anastomoses on clinical outcomes and repeat intervention rates after uterine artery embolization[J].J Vasc Interv Radiol,2006,17:783-789.
[20]Scheurig-Muenkler C,Poellinger A,Wagner M,et al.Ovarian artery embolization in patients with collateral supply to symptomatic uterine leiomyomata[J].Cardiovasc Intervent Radiol,2011,34:1199-1207.
[21]Hu NN,Kaw D,McCullough MF,et al.Menopause and menopausal symptoms after ovarian artery embolization:a comparison with uterine artery embolization controls[J].J Vasc Interv Radiol,2011,22:710-715.
[22]Salazar GM,Gregory Walker T,Gonway RF,et al.Embolization of angiographically visible typeⅠandⅡutero-ovarian anastomoses during uterine artery emboization for fibroid tumors:impact on symptom recurrence and permanent amenorrhea[J].J Vasc Interv Radiol,2013,24:1347-1352.
[23]Campbell J,Rajan DK,Kachura JR,et al.Efficacy of ovarian artery embolization for uterine fibroids:clinical and magnetic resonance imaging evaluations[J].Can Assoc Radiol J,2015,66:164-170.
[24]Kwon JH,Kim MD,Lee KH,et al.Abrrant ovarian collateral originating from external iliac artery during uterine artery embolization[J].Cardiovasc Intervent Radiol,2013,15:243-245.
[25]Smoger DL,Kancherla V,Shlansky-Goldberg RD.Uterine fundal blood supply from an aberrant left ovarian artery originating from the inferior mesenteric artery:implications for uterine artery embolization[J].J Vasc Interv Radiol,2010,21:941-944.
[26]刘正玲,郝长宏,许宗兰.栓塞子宫动脉及供应子宫肌瘤的卵巢动脉治疗子宫肌瘤前瞻性研究[J].介入放射学杂志,2016,25:598-601.
[27]Lee HY,Shin JH,Kim J,et al.Primary postpartum hemorrhage:outcome of pelvic arterial embolization in 251 patients at a single institution[J].Radiology,2012,264:903-909.
[28]汤萍萍,胡惠英,高劲松,等.盆腔动脉栓塞术治疗原发性产后出血的效果及安全性分析[J].中华妇产科杂志,2016,51:81-86.
[29]Wang MQ,Liu FY,Duan F,et al.Ovarian artery embolization supplementing hypogastric-uterine artery embolization for control of severe postpartum hemorrhage:report of eight cases[J].JVasc Interv Radiol,2009,20:971-976.
[30]Cheong JY,Kong TW,Son JH,et al.Outcome of pelvic arterial embolization for postpartum hemorrhage:a retrospective review of 117 cases[J].Obstet Gynecol Sci,2014,57:17-27.
[31]吴普照,张跃伟,赵广生,等.介入栓塞宫颈癌出血伴异位卵巢动脉供血并左髂内动脉缺如一例[J].介入放射学杂志,2014,23:230-231.
[32]赵海,姜峰,张继军,等.针对产后大出血介入治疗时卵巢供血支是否需要栓塞的探究[J].新疆医学,2017,47:184-186.
[33]王春岩,庞桦进,王江云,等.卵巢动脉供血对子宫动脉栓塞术止血效果的影响[J].中国介入影像与治疗学,2015,12:143-146.
[34]Ouyang Z,Liu P,Yu Y,et al.Role of ovarian artery to uterine artery anastomoses in uterine artery embolization:intial anatomic and radiologic studies[J].Surg Radiol Anat,2012,34:737-741.
[35]何俊峰,闫国珍,穆永旭,等.彩色多普勒血流成像在检测子宫动脉栓塞术前后卵巢血流变化中的应用[J].中国医学影像学杂志,2012,20:138-140.
[36]万九峰,董永安,姬超,等.介入栓塞治疗难治性产后出血的临床分析[J].中国医刊,2015,50:82-85.