经阴道彩色多普勒超声评估子宫动脉栓塞术对卵巢功能的影响研究
|
摘要
目的:研究经阴道彩色多普勒超声评估子宫动脉栓塞术对卵巢功能的影响,为临床制订合理的治疗方案提供依据。方法:60例子宫肌瘤患者均在行子宫动脉栓塞术术前及术后1个月、3个月、5个月时行经阴道彩色多普勒超声进行卵巢动脉取样、血流动力学检测,同时通过血液检测性激素水平,对手术前后各时间点数据进行统计学分析,判定子宫动脉栓塞术后卵巢血供改变对卵巢功能的影响。采用SPSS 17.0统计学软件进行数据分析。结果:子宫动脉栓塞术术前及术后1个月、3个月、5个月取样率分别为100%、74%、87%、100%。术后1个月、3个月血管阻抗性与术前比较差异有统计学意义,术后5个月血管阻抗性与术前比较差异无统计学意义。血液中卵泡刺激素(FSH)、黄体生成素(LH)、孕激素(P)、睾酮(T)水平在术后1个月、3个月与术前比较差异有统计学意义,术后5个月与术前比较差异无统计学意义;雌激素(E2)、泌乳素(PRL)水平在术后1个月、3个月和5个月比术前降低,差异有统计学意义;E2水平术后1个月、3个月、5个月呈逐渐升高趋势,术后各时间点比较差异有统计学意义。FSH、PRL水平术后改变情况与手术时间无明显规律性。结论:经阴道彩色多普勒超声可通过血流动力学的检测判定子宫动脉栓塞术对卵巢功能的影响,并可指导临床进行干预性治疗。
Objective To evaluate the effect of uterine artery embolization(UAE) on ovarian function by transvaginal color Doppler ultrasound(TVCDU) evaluation and its clinical significance. Methods Totally 60 cases of hysteromyoma were examined by transvaginal color Doppler ultrasound before and after UAE operation. Before operation and at the 1 st, 3 rd, 5 th month after, ovarian artery sampling and hemodynamic testing were conducted, meanwhile, sex hormone levels were detected by blood, and statistical analysis was executed on the data at various time points. The effect of the change of ovarian bloodsupply was determined on the ovarian function after UAE operation. SPSS 17.0 software was used for data analysis. Results The sampling rates before UAE operation and at the 1 st, 3 rd, 5 th month after were 100%, 74%, 87% and 100% respectively.At the 1 st and 3 rd month after embolization of uterine leiomyoma, it had statistical significance on preoperative and postoperative comparison in vascular impedance, FSH, LH, progestins and testosterone(P <0.05), while it had not after 5 months since operation(P>0.05); when compared with the levels of estrin(E2) and lactotropin(PRL) before UAE operation those at the 1 st, 3 rd, 5 th month after decreased significantly; E2 increased eventually at the 1 st, 3 rd, 5 th month after, and there were obvious differences between the levels of E2 at different time points; there were no significant rules on the changes of FSH and PRL levels after UAE operation corresponding to operation time. Conclusion TVCDU can be used to determine the effect of uterine artery embolization on ovarian function through hemodynamic examination, and can guide clinical intervention therapy. [Chinese Medical Equipment Journal,2019,40(7):58-61]
Objective To evaluate the effect of uterine artery embolization(UAE) on ovarian function by transvaginal color Doppler ultrasound(TVCDU) evaluation and its clinical significance. Methods Totally 60 cases of hysteromyoma were examined by transvaginal color Doppler ultrasound before and after UAE operation. Before operation and at the 1 st, 3 rd, 5 th month after, ovarian artery sampling and hemodynamic testing were conducted, meanwhile, sex hormone levels were detected by blood, and statistical analysis was executed on the data at various time points. The effect of the change of ovarian bloodsupply was determined on the ovarian function after UAE operation. SPSS 17.0 software was used for data analysis. Results The sampling rates before UAE operation and at the 1 st, 3 rd, 5 th month after were 100%, 74%, 87% and 100% respectively.At the 1 st and 3 rd month after embolization of uterine leiomyoma, it had statistical significance on preoperative and postoperative comparison in vascular impedance, FSH, LH, progestins and testosterone(P <0.05), while it had not after 5 months since operation(P>0.05); when compared with the levels of estrin(E2) and lactotropin(PRL) before UAE operation those at the 1 st, 3 rd, 5 th month after decreased significantly; E2 increased eventually at the 1 st, 3 rd, 5 th month after, and there were obvious differences between the levels of E2 at different time points; there were no significant rules on the changes of FSH and PRL levels after UAE operation corresponding to operation time. Conclusion TVCDU can be used to determine the effect of uterine artery embolization on ovarian function through hemodynamic examination, and can guide clinical intervention therapy. [Chinese Medical Equipment Journal,2019,40(7):58-61]
引文
[1] OTTARSDOTTIR H,COHEN S L,COX M,et al. Trends in mode of hysterectomy after the U.S. Food and Drug Administration power morcellation advisory[J]. Obstet Gynecol,2017,129(6):1 014-1 021.
[2]张凌焱,杨建华.子宫肌瘤的诊治进展和争议问题[J].实用肿瘤杂志,2016,31(6):505-507.
[3]卢伟,马军朋. DSA引导下多水平栓塞在子宫肌瘤栓塞治疗中的作用[J].医疗卫生装备,2014,35(12):60-63.
[4] UFLACKER R.血管解剖学图谱——血管造影方法[M].陶晓峰,董生,董伟华,译.天津:天津科技翻译出版公司,2009:647-648.
[5] PAVONE D,CLEMENZA S,SORBI F,et al. Epidemiology and risk factors of uterine fibroids[J]. Best Pract Res Clin Obstet Gynaecol,2018,46:3-11.
[6]王景彩,沈嫱.子宫切除术后对卵巢血流及功能的影响[J].武汉大学学报(医学版),2011,32(3):408-410.
[7] JANSON P O,JANSSON I. The acute effect of hysterectomy on ovarian blood flow[J]. Am J Obstet Gynecol,1977,127(4):349-352.
[8] LIU F,PAN Y,LIANG Y,et al. The epidemiological profile of hysterectomy in rural Chinese women:a population-based study[J]. BMJ Open,2017,30,7(6):e015351.
[9]瞿红,张震宇,刘崇东,等.子宫肌瘤剔除术后复发危险因素的分析[J].实用妇产科杂志,2007,23(12):726-727.
[10]皮冰.子宫肌瘤剔除术后肌瘤复发相关危险因素的分析[J].中华肿瘤防治杂志,2011,18(6):457-459.
[11] RAVINA J H,HERBRETEAU D,CIRARU-VIGNERON N,et al. Arterial embolisation to treat uterine myomata[J]. Lancet,1995,346:671-672.
[12]张电波,肖湘生,欧阳强.子宫肌瘤栓塞术:子宫动脉卵巢支分析[J].放射学实践,2002,17(4):301-302.
[13] FONSECA M C M,CASTRO R,MACHADO M,et al. Uterine artery embolization and surgical methods for the treatment of symptomatic uterine leiomyomas:a systemic review and Metaanalysis followed by indirect treatment comparison[J]. Clin Ther,2017,39(7):1 438-1 455.
[14]刘凤永,王茂强,王志军,等.卵巢动脉的血管造影解剖及其临床意义[J].解剖学杂志,2007,30(6):783-786.
[15] MORI K,SAIDA T,SHIBUYA Y,et al. Assessment of uterine and ovarian arteries before uterine artery embolization:advantages conferred by unenhanced MR angiography[J]. Radiology,2010,255:467-475.
[16] MORI K,SAIDA T,SHIBUYA Y,et al. Unenhanced MR angiography of uterine and ovarian arteries after uterine artery embolization:differences between patients with incomplete and complete fibroid infarction[J]. Cardiovasc Intervent Radiol,2012,35(3):515-522.
[17]王茂强,刘凤永,段峰,等.中国人OVA的血管造影研究[J].临床放射学杂志,2007,26(3):283-287.
[18] MANYONDA I T,BRATBY M,HORST J S,et al. Uterine artery embolization versus myomectomy:impact on quality of life—results of the FUME(Fibroids of the Uterus:Myomectomy versus Embolization)trial[J]. Cardiovasc Intervent Radiol,2012,35(3):530-536.
[19] THABET A,KALVA S P,LIU B,et al. Interventional radiology in pregnancy complications:indications,technique,and methods for minimizing radiation exposure[J]. Radiographics,2012,32(1):255-274.
[20]刘萍,徐玉静,余艳红,等.构建在体胎盘植入数字化三维模型在介入治疗中的应用[J].中国实用妇科与产科杂志,2012(1):27-30.
[21] OUYANG Z,LIU P,YU Y,et al. Role of ovarian artery-touterine artery anastomoses in uterine artery embolization:initial anatomic and radiologic studies[J]. Surg Radiol Anat,2012,34(8):737-741.
[22]吕斌,王琼,牟霜.经阴道彩色多普勒超声检查对卵巢早衰的临床分析[J].重庆医学,2012,41(22):2 302-2 303.
[2]张凌焱,杨建华.子宫肌瘤的诊治进展和争议问题[J].实用肿瘤杂志,2016,31(6):505-507.
[3]卢伟,马军朋. DSA引导下多水平栓塞在子宫肌瘤栓塞治疗中的作用[J].医疗卫生装备,2014,35(12):60-63.
[4] UFLACKER R.血管解剖学图谱——血管造影方法[M].陶晓峰,董生,董伟华,译.天津:天津科技翻译出版公司,2009:647-648.
[5] PAVONE D,CLEMENZA S,SORBI F,et al. Epidemiology and risk factors of uterine fibroids[J]. Best Pract Res Clin Obstet Gynaecol,2018,46:3-11.
[6]王景彩,沈嫱.子宫切除术后对卵巢血流及功能的影响[J].武汉大学学报(医学版),2011,32(3):408-410.
[7] JANSON P O,JANSSON I. The acute effect of hysterectomy on ovarian blood flow[J]. Am J Obstet Gynecol,1977,127(4):349-352.
[8] LIU F,PAN Y,LIANG Y,et al. The epidemiological profile of hysterectomy in rural Chinese women:a population-based study[J]. BMJ Open,2017,30,7(6):e015351.
[9]瞿红,张震宇,刘崇东,等.子宫肌瘤剔除术后复发危险因素的分析[J].实用妇产科杂志,2007,23(12):726-727.
[10]皮冰.子宫肌瘤剔除术后肌瘤复发相关危险因素的分析[J].中华肿瘤防治杂志,2011,18(6):457-459.
[11] RAVINA J H,HERBRETEAU D,CIRARU-VIGNERON N,et al. Arterial embolisation to treat uterine myomata[J]. Lancet,1995,346:671-672.
[12]张电波,肖湘生,欧阳强.子宫肌瘤栓塞术:子宫动脉卵巢支分析[J].放射学实践,2002,17(4):301-302.
[13] FONSECA M C M,CASTRO R,MACHADO M,et al. Uterine artery embolization and surgical methods for the treatment of symptomatic uterine leiomyomas:a systemic review and Metaanalysis followed by indirect treatment comparison[J]. Clin Ther,2017,39(7):1 438-1 455.
[14]刘凤永,王茂强,王志军,等.卵巢动脉的血管造影解剖及其临床意义[J].解剖学杂志,2007,30(6):783-786.
[15] MORI K,SAIDA T,SHIBUYA Y,et al. Assessment of uterine and ovarian arteries before uterine artery embolization:advantages conferred by unenhanced MR angiography[J]. Radiology,2010,255:467-475.
[16] MORI K,SAIDA T,SHIBUYA Y,et al. Unenhanced MR angiography of uterine and ovarian arteries after uterine artery embolization:differences between patients with incomplete and complete fibroid infarction[J]. Cardiovasc Intervent Radiol,2012,35(3):515-522.
[17]王茂强,刘凤永,段峰,等.中国人OVA的血管造影研究[J].临床放射学杂志,2007,26(3):283-287.
[18] MANYONDA I T,BRATBY M,HORST J S,et al. Uterine artery embolization versus myomectomy:impact on quality of life—results of the FUME(Fibroids of the Uterus:Myomectomy versus Embolization)trial[J]. Cardiovasc Intervent Radiol,2012,35(3):530-536.
[19] THABET A,KALVA S P,LIU B,et al. Interventional radiology in pregnancy complications:indications,technique,and methods for minimizing radiation exposure[J]. Radiographics,2012,32(1):255-274.
[20]刘萍,徐玉静,余艳红,等.构建在体胎盘植入数字化三维模型在介入治疗中的应用[J].中国实用妇科与产科杂志,2012(1):27-30.
[21] OUYANG Z,LIU P,YU Y,et al. Role of ovarian artery-touterine artery anastomoses in uterine artery embolization:initial anatomic and radiologic studies[J]. Surg Radiol Anat,2012,34(8):737-741.
[22]吕斌,王琼,牟霜.经阴道彩色多普勒超声检查对卵巢早衰的临床分析[J].重庆医学,2012,41(22):2 302-2 303.