子宫肌瘤剔除术前的子宫动脉栓塞术:值得麻烦吗?

IF 3.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Diane Bula Ibula, Ambre Balestra, Panayiotis Tanos, Michelle Nisolle, Stavros Karampelas
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引用次数: 0

摘要

研究目的本研究比较了接受子宫肌瘤切除术并在术前进行子宫动脉栓塞(UAE)的患者和未进行UAE的患者。主要目的是分析术前栓塞是否能减少围手术期失血和其他相关并发症。次要目标是分析两种技术在生育能力和产科并发症方面的长期结果:观察性队列回顾研究,经布鲁曼大学医院伦理委员会批准(CE2023/79):利用妇科数据库提取2011年1月至2021年12月期间的所有子宫肌瘤剔除术病例。不包括宫腔镜子宫肌瘤切除术:干预措施干预措施:根据术前有无UAE将患者分为两组。UAE和子宫肌瘤剔除术组包括2011年至2020年间的95例患者,而单纯子宫肌瘤剔除术组包括2014年至2021年间的97例患者:术前进行 UAE 的失血量明显降低(175.9 [308.5] mL 对 623.3 [697.5] mL,P 值 结论:我们的研究结果表明,除了估计失血量(EBL)较低外,术前超导可视化手术似乎并不能改善子宫肌瘤切除术的结果,反而有可能增加生育和妊娠相关并发症的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Uterine Artery Embolization before Myomectomy: Is it worth the trouble?

Objectives: This study compared patients who underwent myomectomy with preoperative uterine artery embolization (UAE) to those who underwent surgery without UAE. The primary objective was to analyze whether preoperative embolization reduces perioperative blood loss and other related complications. The secondary objective was to analyze the long-term outcomes of the two techniques in terms of fertility and obstetrical complications.

Design: Observational cohort retrospective study approved by the Brugmann University Hospital's ethics committee (CE2023/79).

Setting: The department of gynecology database was used to extract all myomectomy cases between January 2011 and December 2021. Hysteroscopic myomectomies were excluded.

Patients: 192 patients were included.

Interventions: The population was divided according to the presence or absence of preoperative UAE. The UAE and myomectomy group comprised 95 cases between 2011 and 2020, while the myomectomy-only group consisted of 97 cases between 2014 and 2021.

Measurements and main results: Blood loss was significantly lower when preoperative UAE was performed (175.9 [308.5] mL versus 623.3 [697.5] mL, p-value <0.0001). However, there was no significant difference in postoperative haemoglobin, blood transfusion rate or emergent hysterectomy conversions compared to myomectomy as the only treatment. UAE was associated with complications that may result in infertility, such as adhesions (15.3% UAE group vs. 2.2% non-UAE group, p-value 0.02) and an increased incidence of miscarriage in pregnancies (53.5% UAE group vs. 22.3% non-UAE group, p-value=0.01). Furthermore, in cases where a pregnancy did progress following UAE, later obstetrical complications such as abnormal placentation or uterine rupture were common in the series (21.7% UAE group vs. 0% non-UAE group, p-value=0.03).

Conclusion: The findings of our study indicate that, other than a lower estimated blood loss (EBL), preoperative UAE does not appear to improve the outcome of myomectomies, while potentially increasing the risk of fertility and pregnancy related complications.

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来源期刊
CiteScore
5.00
自引率
7.30%
发文量
272
审稿时长
37 days
期刊介绍: The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.
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