背景:子宫肌瘤是起源于子宫平滑肌细胞的良性肿瘤。这是最常见的妇科疾病,影响高达80%的育龄妇女。子宫肌瘤可引起各种症状,如异常子宫出血,盆腔疼痛,不孕症,妊娠并发症。子宫肌瘤的治疗选择包括药物治疗,手术干预,和微创技术。
目的:比较子宫肌瘤患者行或未行子宫动脉栓塞术(UAE)的卵巢功能。
方法:这项前瞻性队列研究纳入了87例有症状的子宫肌瘤患者,和87例有相同症状但未接受UAE但接受保守治疗或其他治疗的女性。两组的年龄相匹配,身体质量指数,奇偶校验,和子宫肌瘤的基线特征。主要结果是卵巢功能,通过血清卵泡刺激素(FSH)水平评估,黄体生成素(LH),雌二醇(E2),和抗苗勒管激素(AMH),以及卵巢储备测试,如窦卵泡计数(AFC)和卵巢体积(OV)。次要结果是根据月经周期评估的生育能力,排卵,概念,怀孕,和交付。对参与者进行36个月的随访,并在治疗后1、3、6、12、24和36个月进行评估。
结果:研究发现,UAE最常见的次要并发症是73.6%的女性栓塞后综合征,在一周内解决。UAE组与对照组的血清生殖激素(FSH,LH,E2,AMH)和卵巢储备指标(AFC,OV)在治疗后36个月内的任何时间点。此外,在概念上没有显著差异,怀孕,或交货率,两组的平均受孕时间和分娩孕龄相似。出生体重也相当。最后,卵巢功能之间没有显著的相关性,生育率指标,以及使用的栓塞剂的类型或数量或治疗后肌瘤的变化。
结论:UAE导致显著阳性的妊娠结局,治疗后无不良事件,是一种安全有效的子宫肌瘤治疗方法,保留卵巢功能和生育能力。
BACKGROUND: Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus. It is the most common gynecological disorder, affecting up to 80% of women of reproductive age. Uterine fibroids can cause various symptoms such as abnormal uterine bleeding, pelvic pain, infertility, and pregnancy complications. The treatment options for uterine fibroids include medical therapy, surgical intervention, and minimally invasive techniques.
OBJECTIVE: To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization (UAE).
METHODS: This prospective cohort
study enrolled 87 women with symptomatic uterine fibroids who underwent UAE, and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments. The two groups were matched for age, body mass index, parity, and baseline characteristics of uterine fibroids. The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and anti-Müllerian hormone (AMH), as well as ovarian reserve tests, such as antral follicle count (AFC) and ovarian volume (OV). The secondary outcome was fertility that was evaluated based on the menstrual cycle, ovulation, conception, pregnancy, and delivery. The participants were followed-up for 36 months and assessed at 1, 3, 6, 12, 24, and 36 months after treatment.
RESULTS: The
study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women, resolving within a week. No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones (FSH, LH, E2, AMH) and ovarian reserve indicators (AFC, OV) at any point up to 36 months post-treatment. Additionally, there were no significant differences in conception, pregnancy, or delivery rates, with the average time to conception and gestational age at delivery being similar between the two groups. Birth weights were also comparable. Finally, there was no significant correlation between ovarian function, fertility indicators, and the type or amount of embolic agent used or the change in fibroids post-treatment.
CONCLUSIONS: UAE resulted in significantly positive pregnancy outcomes, no adverse events post-treatment, and is a safe and effective treatment for uterine fibroids that preserves ovarian function and fertility.