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目的分析数字减影血管造影(DSA)下选择性行子宫动脉栓塞术(UAE)治疗子宫肌瘤患者的临床疗效,及对患者血管内皮因子(VEGF)、基质金属蛋白酶-2(MMP-2)、肿瘤坏死因子(TNF-α)的影响,探讨DSA下选择性UAE治疗子宫肌瘤的作用机制,指导临床子宫肌瘤患者治疗方案的选择。方法选择2015年2-11月收治的子宫肌瘤患者38例为研究对象,所有患者应用聚乙烯醇(PVA)作为显影剂,在DSA下行选择性UAE手术治疗,患者术后6、12、18个月随访,每次随访测量子宫肌瘤直径变化、子宫体积变化及临床症状改善情况,治疗前穿刺取子宫肌瘤组织、子宫正常组织,随访6、12及18个月时穿刺取子宫肌瘤组织、子宫正常组织,采用免疫组化法测定上述组织的VEGF、MMP-2及TNF-α水平分析DSA下行选择性UAE手术治疗子宫肌瘤的临床疗效。结果 38例患者均成功实施治疗方案并完成随访。术后6、12、18个月子宫肌瘤直径、子宫体积均逐渐变小,与术前比较,差异均有统计学意义(均P<0.05);术后6个月,所有患者的临床症状均消失。术前子宫肌瘤病变组织的VEGF、MMP-2及TNF-α水平均明显高于正常子宫组织,差异均有统计学意义(均P<0.05);术后6、12及18个月患者子宫正常组织的VEGF、MMP-2、TNF-α水平比较,差异均无统计学意义(均P>0.05);肌瘤病变组织随着时间推移,VEGF、MMP-2、TNF-α水平均逐渐降低,与术前比较,差异均有统计学意义(均P<0.05),术后12、18个月与正常组织间比较,差异均无统计学意义(均P>0.05)。结论 DSA下行选择性UAE术治疗子宫肌瘤可有效降低患者子宫肌瘤病变组织的VEGF、MMP-2及TNF-α水平,促进肌瘤的消除,是适合子宫肌瘤患者的治疗方案。
Objective To analyze the clinical efficacy of selective uterine arterial embolization (UAE) in patients with uterine fibroids under digital subtraction angiography (DSA) and to evaluate the clinical effect of vascular endothelial growth factor (VEGF), matrix metalloproteinase-2 (MMP- , Tumor necrosis factor (TNF-α), explore the mechanism of selective UAE treatment of uterine fibroids under DSA, guide the choice of treatment options for patients with clinical uterine fibroids. Methods Thirty-eight patients with uterine myoma treated in our hospital from February to November in 2015 were enrolled in this study. All patients underwent selective UAE surgery with DSA using polyvinyl alcohol (PVA) as a developing agent. After operation, 6,12,18 patients Month follow-up, measurement of changes in uterine fibroids diameter, changes in uterine volume and clinical symptoms of each follow-up, uterine fibroids before treatment, uterine normal tissue, uterine fibroids were followed up for 6, 12 and 18 months The tissue and uterus normal tissues were collected. The levels of VEGF, MMP-2 and TNF-αin the above tissues were detected by immunohistochemistry. The clinical efficacy of DSA descending selective UAE surgical treatment of uterine myoma was analyzed. Results All 38 patients were successfully treated and completed the follow-up. At 6, 12, and 18 months after operation, the diameter of uterine fibroids and the size of the uterus gradually became smaller, which were significantly different from those before operation (all P <0.05). After 6 months, the clinical symptoms All disappear. The levels of VEGF, MMP-2 and TNF-α in preoperative uterine leiomyoma were significantly higher than those in normal uterus (all P <0.05). The uterus of patients with uterine fibroids at 6, 12 and 18 months after operation The levels of VEGF, MMP-2 and TNF-α in normal tissue were not significantly different (all P> 0.05). The levels of VEGF, MMP-2 and TNF-α gradually decreased with time (All P <0.05). There were no significant differences between the two groups at 12 and 18 months after operation (P> 0.05). Conclusion DSA descending selective UAE treatment of uterine fibroids can effectively reduce the levels of VEGF, MMP-2 and TNF-α in patients with uterine myoma lesions, and promote the elimination of fibroids, is a treatment for patients with uterine fibroids.