자궁근종 치료를 위한 자궁동맥 색전술과 자궁동맥 결찰술의 임상적 효과

Abstract

Objective：As a management for general gynecologic disease, only conservative treatment was available for those who needed to save uterus for further fertility. This study aimed to evaluate the effect of laparoscopic uterine artery ligation and uterine artery embolization on the uterine myoma. Methods：Of the 40 women with uterine myoma, 23 patients underweent uterine artery embolization and 17 laparoscopic uterine artery ligation. Polyvinyl alcohol of gelfoam was used for uterine artery embolization. Laparoscopic uterine artery ligation procedure included identification of bilateral ureters first, and peritoneum resection by using the Harmonic Scarpel, followed by bilateral uterine arteries ligation using clips above the ureters. Changes in symptoms and complications were analyzed after the procedures. Results：The uterine volume was reduced 3 months after uterine artery embolization, but thereafter no significant changes were observed thereafter. To the contrast, the uterine volumes were only slightly reduced 3 months after laparoscopic uterine artery ligation, and gradually reduced 6 months later. The average reduction was about 58.5%. After laparoscopic uterine artery ligation, 20% complained of vaginal spotting. Furthermore, the mechanism of volume reduction was evaluated using specimens obtained from biopsy after each procedures. And the results suggested that laparoscopic uterine artery ligation mainly result in physiologic cell death, that is apoptosis, whereas the uterine artery embolization may result in cell necrosis. Conclusion：Uterine artery embolization and laproscopic uterine artery ligation are both effective in relieving symptoms caused by uterine myoma that could replace hysterectomy or myomectomy.