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目的评价子宫肌瘤栓塞中双侧卵巢支被误栓对卵巢功能的影响。方法将在子宫动脉造影中出现双侧卵巢支显影而被误栓的15例子宫肌瘤栓塞病人分成2组,1组是双侧卵巢区有碘油沉积(双侧卵巢碘油沉积组),另1组是双侧卵巢区无碘油沉积、或仅一侧卵巢区有碘油沉积(非双侧卵巢碘油沉积组),分别统计术后闭经的病例,并作Fisher检验。栓塞材料采用超液化碘油和平阳霉素混合液。栓塞前和栓塞6个月后检查促卵泡生成素(FSH)、黄体生成素(LH)和雌二醇(E2),并作t检验。结果15例年龄26~46岁[(39.00±5.62)岁],追踪16~47个月[(30.5±6.4)个月]。12/15的患者月经在栓塞后2~6周[(3.0±0.3)周]恢复,3/15的患者出现闭经,3例术后闭经的性激素呈绝经期改变。双侧卵巢碘油沉积组出现术后闭经(3/3),非双侧卵巢碘油沉积组未出现术后闭经(0/12),两组差异有统计学意义(P=0.00219)。≥45岁的患者有2例,均无术后闭经,<45岁的患者有13例,其中3例出现术后闭经。所有患者在栓塞前和栓塞6个月后的FSH、LH和E2差异无统计学意义(P>0.05)。结论子宫肌瘤栓塞中双侧卵巢支被误栓后,若双侧卵巢区被碘油沉积,术后发生闭经的几率极高。若子宫动脉造影中出现双侧卵巢支显影的肌瘤患者,需要慎重选择栓塞剂,超液化碘油可能不是合适的栓塞材料。单纯的双侧子宫动脉卵巢支的误栓,即没有卵巢血管床的误栓情况下,对卵巢功能的影响可能较小。
Objective To evaluate the effect of misdiagnosis of bilateral ovarian branches on ovarian function in patients with uterine fibroid embolization. Methods Fifteen patients with uterine leiomyoma embolized by uterine artery angiography who had bilateral ovarian branch imaging were divided into two groups. One group had lipiodol deposition (bilateral ovarian lipiodol deposition group) in both ovary areas, In the other group, there was no lipiodol deposition in the bilateral ovarian area or iodized oil deposition in the ovary area on one side only (non-bilateral ovarian lipiodol deposition group). Embolization material using ultra-liquefied lipiodol and bleomycin mixture. Follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) were examined 6 months after embolization and before embolization, and t test was performed. Results Fifteen patients aged 26-46 years (39.00 ± 5.62 years) were followed up for 16-47 months (30.5 ± 6.4 months). Menstruation in 12/15 patients recovered 2 to 6 weeks after embolization (3.0 ± 0.3 weeks), 3 of 15 patients had amenorrhea, and 3 of the menopausal sex hormones were postmenopausal. Postoperative amenorrhea (3/3) occurred in patients with bilateral ovarian lipiodol deposition and no postoperative amenorrhea (0/12) in non-ovarian iodized oil deposition group. There was significant difference between the two groups (P = 0.00219). There were 2 patients ≥45 years of age without any amenorrhea, and 13 patients <45 years of age, 3 of whom had postoperative amenorrhea. There was no significant difference in FSH, LH and E2 between before and after embolization in all patients (P> 0.05). Conclusion After uterine fibroids embolization in the bilateral ovarian branch was misinserted, if the bilateral ovarian area by lipiodol deposition, postoperative amenorrhea probability is very high. If the uterine artery angiography in patients with bilateral ovarian branch imaging of fibroids, need careful selection of embolic agents, ultra-liquefied iodized oil may not be the appropriate embolic material. Simple bilateral uterine artery branch of the misdiagnosis, that is, without the misdiagnosis of ovarian vascular bed, the impact on ovarian function may be smaller.