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目的分析子宫肌瘤的血供特征并提出血管造影分型、探讨血供分型对于栓塞的指导意义。方法50例资料完整、血管造影显示清晰的子宫肌瘤病例,采用Dextran微球子宫动脉栓塞。栓塞前,先作双侧选择性的髂内和子宫动脉血管造影,分析血管造影图像以确定双侧子宫动脉对子宫和子宫肌瘤的血供、血供比例、子宫动脉的跨中线吻合和卵巢实质显影等情况。结果按照双侧子宫动脉对子宫肌瘤的不同供血比例可将之分为3型:单侧供血型、一侧优势型和双侧均势型。50例中,这3型的比例分别为6%(3例,1例右侧,2例左侧)、84%(42例,左右侧优势各21例)和10%(5例)。双侧子宫动脉间存在明显吻合者5例、发现副子宫动脉者2例。有15例可见子宫动脉的卵巢支显影及卵巢实质染色,而通过卵巢血管吻合逆行显示同侧卵巢动脉者为5例,占10%。结论应倡导个体化的子宫肌瘤动脉栓塞策略。根据两侧子宫动脉对子宫肌瘤的不同供血比例合理分配微球栓塞剂。当造影看到卵巢动脉显影时,则宜选择直径大于350μm的微球作子宫动脉栓塞,以保护卵巢功能。
Objective To analyze the blood supply characteristics of uterine fibroids and propose the angiography classification to discuss the guiding significance of blood donation for embolism. Methods 50 cases of complete data, angiography showed a clear case of uterine fibroids, the use of Dextran microspheres uterine artery embolization. Before embolization, first bilateral and bilateral selective iliac and uterine arteriography, angiography analysis of images to determine bilateral uterine and uterine fibroids uterine fibroids blood supply, blood supply ratio, uterine artery cross-midline anastomosis and ovarian Real development and so on. Results According to bilateral uterine artery uterine fibroids different blood supply can be divided into 3 types: unilateral blood supply type, one side of the dominant type and bilateral balance type. Among the 50 cases, the proportions of these three types were 6% (3 cases, 1 case right, 2 cases left), 84% (42 cases, 21 cases left and right) and 10% (5 cases) respectively. Bilateral uterine artery between the obvious agreement in 5 cases, found in 2 cases of deputy uterine artery. There were 15 cases of uterine artery visible ovarian branch imaging and ovarian parenchymal staining, and retrograde ovarian vascular anastomosis showed that the ipsilateral ovarian artery in 5 cases, accounting for 10%. Conclusion Individualized uterine fibroids arterial embolization strategy should be advocated. According to the uterine artery on both sides of the uterine fibroids different blood supply rationally distributed microspheres embolic agent. When angiography to see ovarian artery imaging, it is appropriate to select the diameter of more than 350μm microspheres for uterine artery embolization to protect ovarian function.