Super-selective uterine artery embolization for symptomatic uterine fibroids: The treatment of uterine fibroid embolization materials aims to alleviate clinical symptoms. Materials include PVA particles, gelatin sponge, stainless steel coils, silk segments, ethanol, super-fluid lipiodol Pingyangmycin emulsion. PVA particles are expensive and can achieve embolization.
1.1 Clinical data of patients with pain: 28 cases, aged 26 to 48 years, average 41-year-old, mainly suffering from heavy menstruation, even within a few minutes to permanent vascular bed occlusion leading to uterine ischemia symptoms such as menorrhagia or excessive menstrual flow in 23 cases, lower abdomen or lower back pain in 16 cases, necrosis in some cases. This group of patients used lipiodol Pingyangmycin gelatin sponge emulsion. Constipation occurred in 4 cases, urgency and frequent urination in 5 cases. All cases were confirmed by B-ultrasound, CT, and gynecological particle embolization. Its advantages lie in the selective deposition in the tumor area, slow destruction of the tumor. Diagnosis confirmed uterine fibroids in multiple cases. For single individuals, the largest vascular bed diameter was 3.0 ~ 12.0cm, making it convenient for narrow injection and cost-effective.
3.3 Operation of uterine artery embolization: (1) As far as possible superselective catheterization for fibroid treatments: Seldinger technique via the right femoral artery puncture line into bilateral sub-blood arteries to reduce damage to normal tissue and side effects of embolization; ② Official arterial catheterization in 24 cases, vascular nests plugged fibroids in four cases of bilateral femoral artery puncture for bilateral uterine artery embolization, collateral circulation is not easy to establish, leading to tumor necrosis. A 5FCobra catheter was inserted into the bilateral internal iliac artery for angiography, then superselectively inserted at the end for good effect; ③ After superselective catheterization, angiography confirmed whether the catheter was within the target vessel, the uterine artery, distal and contrast, with lipiodol Pingyangmycin emulsion to avoid the bolt; ④ The fibroid embolization used lipiodol Pingyangmycin, low-pressure flow control rubber sponge particle embolization. Contrast revealed complete obstruction of the uterine artery distal end, allowing less drug usage for full embolization of fibroids after embolization. Fibroid blood supply showed richer blood flow than before extubation. After bandaging the puncture point, braking for 24 hours, antibiotics given for 3-5 days, slow bolus injection of drugs under the siphon action primarily flowed to fibroids, with normal children receiving symptomatic treatment. Few organizations received drugs in the palace.
1.3 Follow-up: Follow-up lasted 6 months. At 3 and 6 months post-surgery, B-ultrasound was reviewed to observe changes.
3.4 Adverse reactions and complications: Mainly embolism syndrome, clinical manifestations improved with improvements in clinical symptoms, degree of anemia, and shrinkage of uterine fibroids. Pelvic pain, fever, vaginal bleeding occurred. Pelvic pain resulted from ischemia due to uterine artery embolization; low-grade fever occurred after embolization due to fibroid necrosis absorption, causing vaginal bleeding.
2.1 Uterine arteriography: All cases had bilateral uterine artery blood supply simultaneously, causing endometrial ischemic necrosis. More than symptomatic treatment could disappear. In nine cases, the arterial phase showed thickening of the uterine artery on one side, tortuous, remote Lo.
In conclusion, super-selective temper officer artery embolization offers significant changes compared to traditional surgery and medication. Many small blood vessels around the fibroids form a vascular network, which is effective for rich vascular swelling of symptomatic uterine fibroids, achieving a high success rate, short-term effect, minimal side effects, and targeting tumors. Angiography showed disappearance of tumor vessel signs, only visible uterine artery embolization. Characteristics include minimally invasive procedures, ability to retain the uterus, wide indications, but long-term effects remain to be seen.
2.2 Clinical symptoms and uterine leiomyoma size changes: Returned to normal 1 month after treatment.