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目的探讨子宫动脉栓塞术(UAE)治疗子宫腺肌病(AM)的中远期疗效。方法对189例AM患者行UAE治疗,术前1个月及术后1、2、3、6、12、18个月及以后每年1次随访观察痛经、月经量的变化。结果(1)随访情况:UAE术后具有完整随访资料者168例,随访率88·9%,平均随访时间(50±15)个月。9例患者因痛经治疗无效或复发等原因而切除子宫。(2)痛经症状的变化:168例患者中,159例术前有痛经症状,UAE治疗后131例(82·4%,131/159)为临床有效,28例(17·6%,28/159)为临床无效,8例(5·0%,8/159)复发。AM合并和未合并子宫肌瘤患者的痛经临床有效率分别为92·9%(39/42)、78·6%(92/117),两者比较,差异无统计学意义(P>0·05);局灶型和弥漫型AM患者的痛经临床有效率分别为82·4%(75/91)、82·4%(56/68),两者比较,差异无统计学意义(P>0·05)。(3)月经量的变化:在168例患者中,93例为月经量过多,UAE术后78例月经量恢复正常,10例出现月经量过少,1例出现暂时性闭经,2例月经量无变化,2例出现月经稀少;74例为月经量正常,术后57例月经量无变化,15例出现月经量过少,2例出现子宫性闭经;1例为月经量过少的患者,术后月经量恢复正常。结论UAE治疗AM具有较好的中远期疗效。
Objective To investigate the long-term effect of uterine artery embolization (UAE) in the treatment of adenomyosis (AM). Methods A total of 189 AM patients underwent UAE treatment. The changes of dysmenorrhea and menstrual flow were observed at 1 month before operation and at 1, 2, 3, 6, 12, 18 months after operation and once after each follow-up. Results (1) Follow-up: There were 168 cases with complete follow-up data after UAE, with a follow-up rate of 88.9% and an average follow-up time of (50 ± 15) months. Nine patients with dysmenorrhea due to ineffective treatment or recurrence and other reasons and removal of the uterus. (2) The changes of dysmenorrhea symptoms: Of the 168 patients, 159 cases had dysmenorrhea symptoms before operation, 131 cases (82.4%, 131/159) were clinically effective after UAE treatment, 28 cases (17.6% 159) were clinically ineffective, and 8 patients (5.0%, 8/159) relapsed. The clinical effective rates of dysmenorrhea in AM patients with and without uterine myoma were 92.9% (39/42) and 78.6% (92/117), respectively, with no significant difference between the two groups (P> 0. 05). The clinical effective rates of dysmenorrhea in patients with focal and diffuse AM were 82.4% (75/91) and 82.4% (56/68), respectively, with no significant difference (P> 0 · 05). (3) The changes of menstrual volume: Of the 168 patients, 93 cases were menorrhagia, 78 menstruation returned to normal after UAE, 10 cases had less menstruation, 1 case had temporary amenorrhea and 2 cases menstruation The amount of menstruation was scarce in 2 cases, the normal menstruation in 74 cases, no change in menstrual flow in 57 cases, the less amount of menstruation in 15 cases, the uterine amenorrhea in 2 cases and the one with less menstruation , Postoperative menstrual volume returned to normal. Conclusion UAE treatment of AM has a better long-term efficacy.