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目的观察卵巢动脉(OVA)参与盆腔疾病供血的出现频次,评价经导管栓塞OVA参与盆腔疾病供血的安全性。方法用前瞻性方法对96例接受髂内-子宫动脉栓塞或化疗栓塞的患者进行了选择性OVA造影术,包括盆腔恶性肿瘤63例、子宫肌瘤17例、产科出血性疾病16例,平均年龄46岁。有盆腔手术史者12例。既往曾行髂内-子宫动脉栓塞术者6例。存在一侧或两侧子宫动脉发育不良者8例,两侧子宫动脉发育良好者(除去手术和已行栓塞治疗的患者)70例。对参与盆腔病变供血的OVA进行了选择性栓塞术,观察OVA参与盆腔疾病供血的频次、影响因素,评价栓塞OVA的安全性和临床意义。结果96例中,两侧OVA插管成功者58例(60.4%),一侧插管成功者38例(39.6%)。选择性造影发现至少有一侧OVA参与盆腔病变供血者33例(34.4%),包括盆腔恶性肿瘤18例、子宫肌瘤5例、产科出血性疾病10例。33例中有盆腔手术史者7例,曾行髂内-子宫动脉栓塞术者5例,存在一侧或两侧子宫动脉发育不良者8例,两侧子宫动脉发育良好者13例。OVA参与盆腔疾病供血的高发因素有:与孕产相关的出血性疾病(χ2=6.73,P=0.009)、既往有盆腔手术史(χ2=3.55,P=0.04)、既往曾行子宫动脉栓塞术(χ2=6.80,P=0.009)、存在一侧或两侧子宫动脉发育不良(χ2=3.40,P=0.04)。对33例参与盆腔供血的OVA进行了栓塞术,操作成功率为100%,无重要并发症。4例与产科相关的出血性疾病,曾行两侧髂内-子宫动脉栓塞后出血未止,经栓塞参与供血的OVA后出血立即停止。4例介入治疗后出现一过性卵巢功能减退症状。结论OVA参与盆腔疾病供血的发生率达34%。在行髂内-子宫动脉栓塞或化疗栓塞术时,如发现OVA参与盆腔病变供血,补充OVA栓塞术是安全和有价值的。
Objective To observe the frequency of ovarian artery (OVA) involvement in pelvic disease and to evaluate the safety of transcatheter occlusion of OVA in pelvic disease. Methods A total of 96 patients undergoing internal iliac-uterine artery embolization or chemoembolization underwent selective OVA radiography, including 63 cases of pelvic malignancies, 17 cases of uterine fibroids, 16 cases of obstetric hemorrhagic disease, and mean age 46 years old. There are 12 cases of pelvic surgery history. Previously performed iliac-uterine artery embolization in 6 cases. There were 8 cases of dysplasia of uterine artery on one or both sides and 70 cases of well-developed uterine artery on both sides (patients undergoing surgery and embolization). The selective embolization of OVA involved in pelvic lesion blood supply was performed. The frequency and influential factors of OVA in pelvic disease were observed. The safety and clinical significance of OVA in embolism were evaluated. Results Among the 96 cases, 58 (60.4%) were successful intubation of OVA on both sides and 38 (39.6%) were successful on the one side of intubation. Selective angiography found that at least one side of the OVA involved in pelvic lesions in 33 patients (34.4%), including 18 cases of pelvic malignant tumors, uterine fibroids in 5 cases, obstetric hemorrhagic disease in 10 cases. Among the 33 cases, there were 7 cases with history of pelvic surgery, 5 cases had undergone internal iliac-uterine artery embolization, 8 cases had uterine arterial dysplasia on one or both sides, and 13 cases had well-developed uterine arteries on both sides. The high incidence of OVA involvement in pelvic diseases was bleeding associated with pregnancy (χ2 = 6.73, P = 0.009), history of pelvic surgery (χ2 = 3.55, P = 0.04), previous uterine artery embolization (χ2 = 6.80, P = 0.009), with one or both uterine arterial dysplasia (χ2 = 3.40, P = 0.04). Thirty-three OVA patients who participated in pelvic feeding were enrolled. The success rate of operation was 100%. There was no significant complication. 4 cases of obstetric-related hemorrhagic disease, had bilateral iliac-uterine artery embolization bleeding has not stopped, the embolization of OVA blood supply immediately stop bleeding. Four cases of transient ovarian dysfunction after interventional treatment. Conclusion The incidence of OVA involvement in pelvic disease is 34%. In the iliac-uterine artery embolization or chemoembolization, if found OVA involved in pelvic lesions, complement the OVA embolization is safe and valuable.