目的:评估子宫切除术或子宫肌瘤切除术前出血风险高的子宫肌瘤患者术前计划子宫动脉栓塞术(UAE)的结果。
方法:对2004年至2019年连续53例接受计划的UAE术后手术的患者进行了回顾性回顾,其中一部分患者被转诊的外科医生认为因大纤维瘤和/或粘连而出血风险很高。最大的纤维瘤的特征,肌瘤总数,栓塞剂,估计失血量(EBL),并发症,并收集了其他因素。
结果:53例患者(平均年龄41岁)在行子宫切除术24(45%)或子宫肌瘤切除术29(55%)之前行选择性阿联酋。阿联酋和手术之间的中位间隔为21.6h(范围1.75h-57天)。在子宫切除术中,13(45%)是开放的,15(52%)宫腔镜和1腹腔镜。肌瘤/患者的平均数量为4.1(SD1.3),平均肌瘤体积为328cm3(范围11-741),最长尺寸的平均肌瘤直径为7.4cm(范围3.2-15)。平均EBL为90(SD为99.5mL)。三名(10%)子宫肌瘤切除术患者需要输血。所有子宫切除术均通过剖腹手术进行。平均肌瘤体积为1699cm3(范围93-9099cm3),平均最大直径为16.2cm(范围6.5-29.6),平均肌瘤为2.4(SD1.7)。平均EBL为352(SD220mL)。四名(17%)子宫切除术的患者需要术中或术后输血。在平均1年随访(范围1个月-14年),70%的UAE子宫肌瘤切除术患者和74%的UAE子宫切除术患者报告症状缓解。3名(6%)患者再次入院:1名患者为骨盘炎,一个伤口裂开,和一个用于子宫肌瘤切除术后感染的保留肌瘤。
结论:计划的术前UAE导致的术中失血与文献中的“全角”子宫肌瘤切除术和子宫切除术患者相似。进一步的研究可能会阐明哪些患者将是这种分阶段治疗范式的最佳候选人。
OBJECTIVE: To assess outcomes of planned pre-operative uterine artery embolization (UAE) in patients with uterine fibroids at high risk for bleeding prior to hysterectomy or myomectomy.
METHODS: A retrospective
review of 53 consecutive patients who underwent planned UAE followed by surgery from 2004 to 2019 was performed in a subset of patients deemed high risk for bleeding by the referring surgeon due to bulky fibroids and/or adhesions. Characteristics of the largest
fibroid, total number of fibroids, embolic agents, estimated blood loss (EBL), complications, and other factors were collected.
RESULTS: 53 patients (mean age = 41) had an elective UAE prior to a hysterectomy 24 (45%) or myomectomy 29 (55%). Median interval between UAE & surgery was 21.6 h (range 1.75 h-57 days). Of the myomectomies, 13 (45%) were open, 15 (52%) hysteroscopic and 1 laparoscopic. Mean number of fibroids/patient was 4.1 (SD 1.3), mean
fibroid volume was 328 cm3 (range 11-741), and the mean
fibroid diameter in longest dimension was 7.4 cm (range 3.2-15). Mean EBL was 90 (SD 99.5 mL). Three (10%) myomectomy patients required blood transfusion. All hysterectomies were via a laparotomy. Mean
fibroid volume was 1699 cm3 (range 93-9099 cm3) with a mean maximum diameter of 16.2 cm (range 6.5-29.6) and an average of 2.4 (SD 1.7) fibroids. Mean EBL was 352 (SD 220 mL). Four (17%) hysterectomy patients required an intra- or post-operative blood transfusion. At a mean 1-year follow-up (range 1 month-14 years), 70% of UAE-myomectomy patients and 74% of UAE-hysterectomy patients reported symptom resolution. Three (6%) patients were readmitted: one for osteodiscitis, one wound dehiscence, and one for an infected retained fibroid after myomectomy.
CONCLUSIONS: Planned pre-operative UAE resulted in intraoperative blood loss similar to \"all-comer\" myomectomy and hysterectomy patients in the literature. Further studies may elucidate which patients would be the best candidates for this staged treatment paradigm.