1995年法國Ravina在Lancet雜志上首次發表了子宮肌瘤的栓塞治療，1997年Goodwin發表在美國應用經子宮動脈栓塞治療子宮肌瘤的經驗，此后子宮動脈栓塞治療子宮肌瘤在全球范圍內廣泛應用。

根據美國介入放射學會的調查，從1997年到2000年已有超過1萬子宮肌瘤患者接受了子宮肌瘤栓塞治療，而且接受治療的患者還在增加。

隨著2007年Volkers在美國婦科與產科雜志和Edwards在新英格蘭雜志發表兩份子宮肌瘤栓塞與子宮肌瘤外科手術治療的隨機對照研究，其結果最終確立了子宮動脈栓塞治療是子宮肌瘤的治療方法之一。

子宮動脈栓塞治療子宮肌瘤的技術成功率為96%；減少對子宮肌瘤所致的月經量過多的癥狀超過90%；子宮肌瘤體積縮小約50%-60%。

子宮肌瘤栓塞是指經雙側子宮動脈注入顆粒性栓塞劑堵塞細動脈水平的血流，造成子宮肌瘤不可逆性的缺血損傷同時避免對子宮的永久性損傷。

技術操作簡單，一般大家最關心兩個問題

1．栓塞劑的選擇：

UAE可供選擇的栓塞劑較多，一般選擇顆粒型栓塞劑，總體可分為可吸收和不可吸收兩種，可吸收栓塞劑以海藻酸鈉微球顆粒（KMG）為代表，不可吸收栓塞劑以聚乙烯醇（PVA）為代表。而其他器官的常用栓塞劑如鋼圈、無水乙醇、超液態碘油等不建議在UAE中使用。

栓塞劑顆粒大小的選擇：栓塞劑的顆粒直徑以500~700 μm為主，部分也可選擇300~500 μm或700~900 μm。

栓塞后立即切除的肌壁間纖維瘤（F）周圍標本的顯微照片（蘇木精-番紅-伊紅染色;放大倍數為200倍）顯示，直徑為500-700 μ m的校準微球（箭頭）靶向閉塞了纖維瘤周圍動脈叢。

例如，對于子宮肌瘤患者的UAE，一般選擇直徑500~700 μm的顆粒進行單一栓塞；也可以選擇直徑300~500 μm的顆粒進行內層血管網栓塞，再用500~700 μm的顆粒進行外層血管網的栓塞，最后用700~900 μm的顆粒進行主干栓塞的"三層栓塞法"[14]。

而子宮腺肌病由于內層血管網較為細小，外層血管網不明顯，為達到較好的栓塞效果可適當選擇較小顆粒的栓塞劑。動脈栓塞的效果與栓塞劑顆粒大小成反比。

2．栓塞程度：

栓塞分為完全性栓塞和不完全性栓塞兩種。

判斷不完全性栓塞，其根據是盡可能地只栓塞病灶的血管網而不栓塞子宮的正常血管網，在DSA中影像學表現為病灶血管網全部或部分消失，子宮的血管網存在，子宮動脈顯影。

另1種為完全性栓塞，即將栓塞劑盡可能多地釋放，將病灶血管網和子宮動脈對病灶主要供血的分支動脈主干完全栓塞，在DSA中影像學表現為病灶染色完全消失，子宮動脈的主干僅部分顯影或完全不顯影。

為獲得更好的臨床療效，子宮腺肌病的栓塞程度要明顯高于子宮肌瘤，而且必須是完全性栓塞。

（有一篇鏈接：點擊）

Abstract 摘要

Uterine fibroids and adenomyosis are prevalent benign neoplasms that can lead to serious deleterious health effects including life-threatening anemia, prolonged menses, and pelvic pain; however, up to 40% of women remain undiagnosed. Traditional treatment options such as myomectomy or hysterectomy can effectively manage symptoms but may entail longer hospital stays and hinder future fertility. Endovascular treatment, such as uterine artery embolization (UAE), is a minimally invasive procedure that has emerged as a well-validated alternative to surgical options while preserving the uterus and offering shorter hospital stays. Careful patient selection and appropriate techniques are crucial to achieving optimal outcomes. There have been advancements in recent times that encompass pre- and postprocedural care aimed at enhancing results and alleviating discomfort prior to, during, and after UAE. Furthermore, success and reintervention rates may also depend on the size and location of the fibroids. This article reviews the current state of endovascular treatments of uterine fibroids and adenomyosis.
子宮肌瘤和腺肌癥是常見的良性腫瘤，可能導致嚴重的有害健康影響，包括危及生命的貧血、月經延長和盆腔疼痛；然而，高達 40%的女性未得到診斷。

傳統的治療方法，如肌瘤切除術或子宮切除術，可以有效地管理癥狀，但可能需要更長的住院時間并阻礙未來的生育。血管內治療，如子宮動脈栓塞（UAE），是一種微創手術，已成為手術選擇的良好替代方案，同時保留子宮并縮短住院時間。仔細的患者選擇和適當的技術對于實現最佳結果至關重要。近年來，在術前和術后護理方面取得了進展，旨在提高結果并減輕 UAE 術前、術中及術后的不適。此外，成功率和再次干預率也可能取決于肌瘤的大小和位置。本文回顧了子宮肌瘤和腺肌癥的血管內治療現狀。

Keywords:fibroid, adenomyosis, embolization, uterine artery embolization, interventional radiology
關鍵詞：子宮肌瘤、腺肌病、栓塞、子宮動脈栓塞、介入放射學

先說結論：血管內治療對腺肌病和子宮肌瘤都很有希望且有效。雖然傳統的手術方法在過去已經取得了成功，但與之相關的并發癥增加和住院時間延長。子宮動脈栓塞等血管內治療具有微創和并發癥極少的優點。需要注意的是，一些患者更喜歡侵入性較小的治療方案。因此，醫療保健提供者應提供關于所有可用治療方案的全面咨詢，這可能包括保守治療、藥物治療、微創治療、手術治療或其組合，以幫助患者就其護理做出明智的決定?？傊A計血管內治療在未來作為纖維瘤和腺肌病的管理工具將發揮更重要的作用。

Uterine fibroids and adenomyosis are common gynecological conditions that can lead to increased morbidity and negatively impact women's quality of life. According to Krentel and De Wilde, 1 adenomyosis was found 40% of the time in patients who underwent a hysterectomy for general uterine complications. Despite their prevalence, approximately 35 to 50% of women would have evidence of undiagnosed fibroids through ultrasound. 2 Along with their asymptomatic nature, they can manifest as prolonged menstrual bleeding that often results in pelvic pain, iron-deficiency anemia, and infertility. 3 While myomectomy and hysterectomy are well-established surgical options, these options are invasive and result in women having prolonged hospitalization times. 4 Uterine artery embolization is a uterus-sparing nonsurgical option, and it is widely reported to involve shorter hospital lengths of stay and less postprocedural pain. 5 This review aims to discuss the current endovascular treatment trends for uterine fibroids and adenomyosis.
子宮肌瘤和腺肌癥是常見的婦科疾病，可能導致發病率增加并負面影響女性的生活質量。根據 Krentel 和 De Wilde 的研究，40%的因一般子宮并發癥而行子宮切除術的患者被診斷為腺肌癥。盡管它們很普遍，大約有 35%至 50%的女性通過超聲檢查會有未診斷的子宮肌瘤的證據。除了它們的無癥狀性質外，它們可以表現為長期月經出血，這通常會導致盆腔疼痛、缺鐵性貧血和不孕。雖然肌瘤切除術和子宮切除術是已確立的手術選擇，但這些選擇是侵入性的，導致女性住院時間延長。子宮動脈栓塞是一種保留子宮的非手術選擇，廣泛報道其涉及更短的住院時間和較少的術后疼痛。本綜述旨在討論目前子宮肌瘤和腺肌癥的血管內治療趨勢。

Patient Selection 患者選擇

UAE is a treatment option for adenomyosis and uterine fibroids, with both entities sharing common symptoms including prolonged menstrual bleeding, pelvic pressure, and dyspareunia. Patients commonly experience some form of combination of these symptoms; however, confirmation with history, physical exam, and imaging findings remains key to ensure that other conditions that often can present with similar symptoms are appropriately excluded. 6 The Uterine Fibroid Symptom Health-Related Quality of Life Questionnaire (UFS-QOL) is a tool specifically designed to assess the symptoms associated with uterine fibroids. The UFS-QOL was developed to measure symptoms and health-related quality of life in women with uterine fibroids. 7
UAE是治療腺肌病和子宮肌瘤的一種選擇，這兩種疾病都共有一些常見癥狀，包括月經出血延長、盆腔壓迫癥狀和性交疼痛?；颊咄ǔ羞@些癥狀的一種或幾種的組合；然而，通過病史、體格檢查和影像學檢查進行確認，仍然是確保適當排除其他可能具有類似癥狀的疾病的關鍵。 6 子宮肌瘤癥狀與健康相關生活質量問卷（UFS-QOL）是一種專門設計來評估與子宮肌瘤相關癥狀的工具。UFS-QOL 旨在測量患有子宮肌瘤女性的癥狀和與健康相關的生活質量。 7

Image modalities such as contrast-enhanced magnetic resonance imaging (MRI) and transvaginal ultrasound (TVUS) are the preferred methods to evaluate size, location, and number of fibroids. 8 Adenomyosis is often diagnosed on TVUS with the hallmark finding of a thickened endometrium and the presence of myometrial cysts. 9 Similarly, on MRI, adenomyosis is identified by myometrial cysts and a thickened junctional zone exceeding 12 mm. 9 On the other hand, uterine fibroids are usually defined by specific characteristics and enhancement patterns seen on MRI. 10 Highly cellular fibroids demonstrate a high signal intensity on T2-weighted images (WI) with characteristic avid postcontrast enhancement. However, degenerated fibroids tend to appear highly variable on MRI. 10 A study of 30 patients by ?ak?r et al 11 found that fibroids with higher T2-WI signal intensity in the preprocedural MRI were associated with a higher rate of post-UAE technical success.
影像學檢查方法，如對比增強磁共振成像（MRI）和經陰道超聲（TVUS），是評估子宮肌瘤大小、位置和數量的首選方法。 8 子宮腺肌病通常通過 TVUS 診斷，標志性發現為子宮內膜增厚和肌層囊腫的存在。 9 類似地，在 MRI 上，子宮腺肌病通過肌層囊腫和超過 12 毫米的增厚交界區來識別。 9 另一方面，子宮肌瘤通常通過 MRI 上的特定特征和增強模式來定義。 10 高細胞密度的子宮肌瘤在 T2 加權圖像（WI）上表現出高信號強度，并具有特征性的對比增強。然而，退化的子宮肌瘤在 MRI 上往往表現出高度可變性。 10 ?ak?r 等人的一項針對 30 名患者的調查顯示，術前 MRI 中 T2-WI 信號強度較高的子宮肌瘤與 UAE 術后技術成功率較高的相關性。

Fibroid Location 子宮肌瘤位置

During the initial patient encounter, clinicians should pay close attention to the location of the fibroids. Appropriately classifying fibroids is necessary for treatment planning and complication prevention. The Federation Internationale de Gynecolgie et Obstetriqueue (FIGO) classification system was developed to uniformly and consistently describe and classify uterine fibroid to facilitate communication, clinical care, and research ( Fig. 1 ). The FIGO system categorizes fibroids that are submucosal, other fibroids, and hybrid fibroids. The recent article by Munro et al 12 proposed an MRI reporting template for structured reporting of uterine fibroids using the FIGO classification system. While the FIGO classification system guides physicians with a more standardized algorithm for describing as well as characterizing uterine fibroids and treatment decision making, clinical findings and patient preference play an important role as well in deciding the best treatment strategy. Also, significant inter-reader variability has been found between gynecologists and radiologists when reporting FIGO types. In 2017, Lacayo et al 13 conducted a study that showed that the size of uterine fibroids did not affect the infarction rate, but rather the location of the fibroid was the only influencing factor. Pedunculated serosal tumors were less likely to have complete infarction compared to transmural fibroids. Additionally, multivariate analysis revealed that fibroids located at the cervix and lower uterine body, as well as the anterior wall of the uterus, were more likely to have an incomplete infarction. However, the reasons for this finding remain unclear and may be related to collateral arterial supply.
在初次接診患者時，臨床醫生應密切關注子宮肌瘤的位置。對子宮肌瘤進行適當的分類對于治療計劃和并發癥預防是必要的。國際婦產科學會（FIGO）的分類系統是為了統一和一致地描述和分類子宮肌瘤，以促進溝通、臨床護理和研究而開發的（ Fig. 1 ）。

FIGO 系統將子宮肌瘤分為黏膜下肌瘤、其他肌瘤和混合肌瘤。

Munro 等人最近的文章 12 提出了使用 FIGO 分類系統對子宮肌瘤進行結構化報告的 MRI 報告模板。雖然 FIGO 分類系統為醫生提供了更標準化的算法來描述和表征子宮肌瘤以及治療決策，但在決定最佳治療方案時，臨床發現和患者偏好也起著重要作用。此外，在報告 FIGO 類型時，婦科醫生和放射科醫生之間發現了顯著的閱讀者間差異。 2017 年，Lacayo 等人進行了一項研究，該研究顯示子宮肌瘤的大小不影響梗死率，而是肌瘤的位置是唯一的影響因素。

有蒂漿膜下腫瘤比穿透性肌瘤發生完全梗死的可能性更低。此外，多變量分析顯示，位于宮頸和子宮下段以及子宮前壁的肌瘤更容易發生不完全梗死。然而，這一發現的原因尚不清楚，可能與側支動脈供應有關。

Fig. 1. 圖 1.

根據 FIGO 分類，子宮肌瘤的亞型根據是否存在黏膜下成分分為兩組。

具有黏膜下成分的子宮肌瘤包括

0 型（有蒂宮腔內）、

1 型（黏膜下成分≥50%）、

2 型（黏膜下成分<50%）和

混合型子宮肌瘤（2-5 型）。

另一方面，無黏膜下成分的子宮肌瘤包括

3 型（子宮內膜接觸的肌壁間子宮肌瘤）、

4 型（無子宮內膜接觸的肌壁間子宮肌瘤）、

5 型（≥50%漿膜下成分的肌壁間子宮肌瘤）、

6 型（<50%漿膜下成分的肌壁間子宮肌瘤）、

7 型（有蒂漿膜下）、

8 型（非子宮肌層位置，如宮頸、闊韌帶或寄生性子宮肌瘤）。

EIA，外髂動脈；IIA，內髂動脈。（數字插圖由 Merve Ozen，MD 制作。）

Koziarz et al 14 conducted a meta-analysis of seven observational studies on UAE in patients with pedunculated subserosal fibroids to evaluate the effectiveness and safety of this treatment. The analysis showed that the risk of adverse events after UAE in patients with pedunculated subserosal fibroids was 1.7%. Furthermore, all adverse events were classified as mild using the SIR guidelines. 15
科齊亞茨等人對七項關于 UAE治療有蒂漿膜下子宮肌瘤患者的觀察性研究進行了薈萃分析，以評估該治療的有效性和安全性。分析顯示，有蒂漿膜下子宮肌瘤患者在接受 UAE 治療后發生不良事件的概率為 1.7%。此外，所有不良事件均根據 SIR 指南被歸類為輕微。

Fibroids that are mainly submucosal or transmural, with a volume of less than 66 mL, are more likely to be expelled following UFE. The average timeframe for fibroid expulsion after UFE is 15 weeks, with most occurrences taking place within 3 months. However, some expulsions have been recorded as early as a few days after the procedure, while others have been reported as late as 50 months after. Typically, the size of expelled fibroids is around 6 to 8 cm on average. 16 These conflicting findings suggest that further investigation is necessary to determine whether certain locations of fibroids may be more prone to incomplete treatment by UAE. There are only case reports documenting instances of expulsion following UAE for adenomyosis.
子宮肌瘤主要為黏膜下或穿透肌層，體積小于 66 毫升的，在 UFE 后更容易排出。UFE 后子宮肌瘤排出的平均時間為 15 周，大多數情況發生在 3 個月內。然而，有些排出發生在手術后的幾天內，而有些則報告發生在術后 50 個月。通常，排出的子宮肌瘤大小平均為 6 到 8 厘米。這些相互矛盾的結果表明，有必要進一步調查以確定某些子宮肌瘤的位置是否可能更容易受到 UAE 的不完全治療。目前只有關于 UAE 后腺肌癥排出的病例報告。

Contraindications 禁忌癥

The presence of an intrauterine device is not an absolute contraindication for UAE, and its removal prior to UAE is not mandatory but accepted as a relative contraindication. Absolute contraindications for UAE include a viable pregnancy, an active infection, and gynecologic malignancy. 17 Other relative contraindications that require extra caution are coagulopathy, severe contrast agent allergy, renal impairment, immunocompromised patients, chronic endometritis, and previous pelvic irradiation or surgery. 17 Intracavity fibroids are another relative contraindication for UAE as they have a higher rate of sepsis and fibroid expulsion, which will be discussed in an upcoming section. While a myomectomy has been limited by fibroid size and number, it has been found that a combined approach of both UAE and myomectomy for intracavity fibroids may be a safe and effective approach. 18
宮內節育器的存在不是 UAE 的絕對禁忌癥，在 UAE 之前移除它不是強制性的，但被視為相對禁忌癥。

UAE 的絕對禁忌癥包括懷孕、活動性感染和婦科惡性腫瘤。

其他需要額外小心的相對禁忌癥包括凝血病、嚴重對比劑過敏、腎功能損害、免疫抑制患者、慢性子宮內膜炎以及既往盆腔放療或手術。 17

宮腔內肌瘤是 UAE 的另一個相對禁忌癥，因為它們有更高的敗血癥和肌瘤排出率，這將在下一節中討論。雖然子宮肌瘤切除術受肌瘤大小和數量的限制，但發現對于宮腔內肌瘤，UAE 和子宮肌瘤切除術的聯合方法可能是一種安全有效的途徑。 17

Procedural Workup 程序評估

UAEs are best performed as part of a collaborative effort between the interventional radiologist and gynecologist who has already discussed medical and surgical options with the patient. The interventional radiologist should set up a consultation before the procedure to review the patient's demographic information and symptoms and assess the risk for the procedure to see if the patient is a good candidate for UAE. 19
UAEs 最好作為介入放射科醫生和已經與患者討論過醫療和手術方案的婦科醫生之間的協作努力的一部分進行。介入放射科醫生應在手術前安排會診，以審查患者的人口統計信息和癥狀，并評估手術風險，以確定患者是否是 UAE 的良好候選人。

As many as two-thirds of all women will have one or more fibroids in their lifetime, and only a fourth of them will have symptoms significant enough to warrant treatment. Symptoms may include abnormal uterine bleeding (AUB), bulk and pressure symptoms, and urinary symptoms. Pregnancy or fertility complications can also be associated with fibroids. 20
多達三分之二的女性在其一生中會患有至少一個子宮肌瘤，其中只有四分之一的人會出現足夠嚴重的癥狀需要治療。癥狀可能包括異常子宮出血（AUB）、體積和壓迫癥狀，以及排尿癥狀。子宮肌瘤還可能與妊娠或生育并發癥相關。

Patients with fibroids experiencing AUB should also be evaluated for other possible causes of abnormal bleeding. A thorough history and physical examination are essential. The International Federation of Gynecology and Obstetrics classifies AUB using PALM-COIEN. PALM represents anatomic etiologies, including polyps, adenomyosis, leiomyomas, and malignancy. COIEN represents medical causes, including coagulopathies, ovulatory dysfunction, endometrial, iatrogenic, and not otherwise specified. Imaging, such as TVUS and MRI, can identify most anatomic etiologies, except for malignancies. All patients should undergo cervical cancer screening, and patients older than 45 or 40 years with risk factors for endometrial adenocarcinoma, including obesity or another history of unopposed estrogen, should undergo endometrial sampling, either with an office biopsy or a dilation and curettage in the office prior to undergoing further management. 21
子宮肌瘤患者出現異常子宮出血（AUB）時，還應評估其他可能的異常出血原因。詳細的病史和體格檢查是必不可少的。國際婦產科學會聯合會使用 PALM-COIEN 對 AUB 進行分類。

PALM 代表解剖學病因，包括息肉、腺肌病、平滑肌瘤和惡性腫瘤。COIEN 代表醫學原因，包括凝血病、排卵功能障礙、子宮內膜、醫源性和未指定的其他原因。

影像學檢查，如經陰道超聲（TVUS）和磁共振成像（MRI），可以識別大多數解剖學病因，但不能識別惡性腫瘤。所有患者都應進行宮頸癌篩查，并且年齡超過 45 歲或 40 歲且具有子宮內膜腺癌風險因素的患者，包括肥胖或未經拮抗的雌激素病史，應在進行進一步管理之前進行子宮內膜取樣，無論是通過門診活檢還是門診擴張刮宮。

Patients with urinary symptoms or infertility should complete full workups by specialists in urinary dysfunction and infertility, respectively, before undergoing intervention of fibroids for these conditions. If fibroids are asymptomatic, patients and their doctors should discuss whether intervention is needed. For example, a patient who has infertility should make sure their partner undergoes a semen analysis prior to undergoing an invasive procedure with the expectation of solving their infertility.
患者在進行子宮肌瘤干預之前，應分別由泌尿功能障礙和不孕癥專家進行全面檢查。如果子宮肌瘤無癥狀，患者和醫生應討論是否需要干預。例如，不孕癥患者在進行旨在解決其不孕癥的侵入性手術之前，應確保其伴侶進行精液分析。

Patients undergoing any procedure should not only understand the risks and benefits but also the alternatives for that procedure. As most women with fibroids are asymptomatic, many only need reassurance. For those suffering from AUB, hormonal intervention, including combined hormonal contraception, progesterone therapy, including systemic and intrauterine devices, as well as gonadotropin-releasing hormone agonists or antagonists, can be considered. Many patients looking into UAE have already been counseled on hysterectomy and myomectomy. However, a hysteroscopic myomectomy can treat the problem with minimal recovery if bleeding symptoms are related to an intracavitary fibroid, provided it is amenable to hysteroscopic resection.
患者在接受任何手術時，不僅應了解手術的風險和益處，還應了解該手術的替代方案。由于大多數子宮肌瘤女性沒有癥狀，許多人只需要得到安慰。對于患有異常子宮出血（AUB）的女性，可以考慮激素干預，包括復方激素避孕藥、孕激素治療，包括全身和宮內裝置，以及促性腺激素釋放激素激動劑或拮抗劑。許多考慮進行 UAE（子宮動脈栓塞術）的患者已經接受了子宮切除術和肌瘤切除術的咨詢。然而，如果出血癥狀與宮腔內肌瘤有關，并且適合進行宮腔鏡下切除，那么宮腔鏡下肌瘤切除術可以以最小的恢復期治療該問題。

Procedure 程序
Anatomy 解剖學

Uterine arteries can have many variants occurring in up to 10 to 15% of the population. 22 During the procedure, it is important to examine the anterior division of the iliac artery since, in 51% of cases, the uterine artery arises from it 22 ( Fig. 2 ). While there are many variants, branches on both sides of the body are symmetrical in 91% of patients. 22
子宮動脈在人群中可存在多種變異，發生率高達 10%至 15%。 22 在手術過程中，檢查髂動脈前支非常重要，因為在 51%的病例中，子宮動脈由此處起源 22 （ Fig. 2 ）。盡管存在許多變異，但在 91%的患者中，身體兩側的分支是對稱的。 22

Fig. 2. 圖 2。

( a ) 1 型指的是最常見的情況，即子宮動脈起源于臀下動脈。

( b ) 2 型中，子宮動脈是臀下動脈的第二或第三分支，而陰部內動脈等其他分支可能是第一分支。

( c ) 3 型以臀下動脈、臀上動脈和子宮動脈都起源于同一水平（三叉）為特征。

( d ) 最后，4 型是指子宮動脈起源于臀下動脈和臀上動脈之前。(數字插圖由 Merve Ozen，MD 提供。)（沒必要記，見招拆招就行）

In 10% of patients, ovarian arteries can provide collateral arterial supply for adenomyosis and fibroids. Several studies have concluded that some failures after UAE have been associated with underlying ovarian collateral supply of the uterus. 23 24 25 26 Other collateral supply sources, such as the round ligament and inferior mesenteric arteries, have also been reported in case reports. One fear clinicians have in performing ovarian artery embolization is ovarian failure. There is also contradictory literature with Razavi et al 27 concluding that ovarian artery embolization should only be performed unilaterally. Most recent discussions about ovarian artery embolization are based on case reports and mostly retained ovarian function after the procedure. 28 In the FIRSTT study where UAE was compared with MRI-guided focused US (MRgFUS), UAE showed a significantly greater absolute decrease in anti-Müllerian hormone levels at 24 months compared with MRgFUS. 29 However, a higher incidence of a second fibroid procedure was observed in patients who underwent MRgFUS compared to those who underwent UAE, and the degree of symptom alleviation was comparatively lower with MRgFUS.
在 10%的患者中，卵巢動脈可以為腺肌癥和子宮肌瘤提供側支動脈供應。幾項研究得出結論，UAE（子宮動脈栓塞術）后的某些失敗與子宮的潛在卵巢側支供應有關。

其他側支供應來源，如圓韌帶和腸系膜下動脈，也有病例報告。。臨床醫生在進行卵巢動脈栓塞時擔心的是卵巢功能衰竭。 關于卵 巢動脈栓塞的文獻也存在矛盾，Razavi 等人認為卵巢動脈栓塞應僅限單側進行。最近關于卵巢動脈栓塞的討論主要基于病例報告，并且大多數情況下術后卵巢功能得以保留。

在 FIRSTT 研究中，UAE 與 MRI 引導的聚焦超聲（MRgFUS）進行了比較，UAE 在 24 個月時與 MRgFUS 相比，抗米勒管激素（ anti-Müllerian hormone） 水平顯著降低。然而，與 UAE 相比，接受 MRgFUS 的患者中觀察到第二次子宮肌瘤手術的發生率更高，并且與 MRgFUS 相比，癥狀緩解程度較低。（譯者：海扶刀消融遜于UAE，當然也有人持保留態度，目前仍有爭議，需要更多RCT研究數據）

Vascular Access 血管通路

UAE is traditionally performed using femoral artery access, but in recent years, radial artery access has become more prevalent. Growing literature demonstrates increased success rate and decreased incidence of complications, leading us to consider transradial (TR) access as a preferred option for UAE. In some clinical situations, an alternative route to the more conventional transfemoral access (TFA) is a necessity, such as obesity and extensive peripheral lower extremity vascular disease. 30
UAE 傳統上使用股動脈通路進行手術，但近年來，橈動脈通路的使用越來越普遍。越來越多的文獻表明，經橈動脈（TR）通路的成功率提高，并發癥發生率降低，這使我們考慮將 TR 通路作為 UAE 的首選方案。在某些臨床情況下，與更傳統的經股動脈通路（TFA）相比，選擇替代通路是必要的，例如肥胖和廣泛的周圍下肢血管疾病。

The results of Sher et al's 31 retrospective study involving 374 patients are promising, as it suggests that TR UAE for symptomatic fibroids can be performed using a same-day discharge protocol with low rates of patient return. Additionally, Nakhaei et al 32 found that TRA UAE resulted in only five access site hematomas in 90 patients and one vasospasm in 92 cases, which is also reassuring for TR access.
Sher 等人進行的涉及 374 名患者的回顧性研究結果顯示令人鼓舞，因為它表明，對于有癥狀的子宮肌瘤，可以使用同一天出院方案進行經皮經腔子宮動脈栓塞術（TR UAE），且患者返院率低。此外，Nakhaei 等人發現，在 90 名患者中，經皮經腔子宮動脈栓塞術（TRA UAE）僅導致 5 個穿刺部位血腫，在 92 個病例中導致 1 例血管痙攣，這也對 TR 途徑是令人放心的。

Embolic Agents 栓塞劑

One area of active research in UAE is the different embolic agents. During UAE, specific embolic agents must be used based on the physicians' experience as well as the size and location of the fibroids. 13 Several different embolic agents have been approved by the FDA for use in UAE, including polyvinyl alcohol particles (PVAs) and tris-acryl gelatin microspheres (TAGMs). A systemic review found that PVA was better at complete fibroid infarction after the first 24 hours when compared to TAGMs, but TAGM was better than PVA at <90% infarction rate outcome. 33 Regardless, nonspherical PVA particles and TAGMs produced similar rates of uterine fibroid infarction. 13
UAE研究活躍的一個領域是不同的栓塞劑。在 UAE 過程中，必須根據醫生的經驗以及子宮肌瘤的大小和位置來選擇特定的栓塞劑。FDA 已批準多種栓塞劑用于 UAE，包括聚乙烯醇顆粒（PVAs）和三丙烯酸凝膠微球（TAGMs）。一項系統綜述發現，與 TAGMs 相比，PVA 在首次 24 小時后對完全子宮肌瘤梗塞的效果更好，但 TAGM 在<90%梗塞率的結果上優于 PVA。無論如何，非球形 PVA 顆粒和 TAGMs 產生相似的子宮肌瘤梗塞率。

Calibrated microspheres are another type of embolic agent that is commonly used in the UAE. An advantage of calibrated microspheres is that, unlike PVA, they are more uniform in size, which results in more predictable embolization and minimizes the clogging of the catheters used during UAE. 34 In a prospective multicenter study, microspheres showed a low rate of adverse events, reduced uterine fibroid volumes, and improved quality of life. 35 In another prospective clinical trial, 8Spheres (Suzhou Hengrui Callisyn Biomedical Technology, China), a type of conformal microsphere, has been shown to relieve heavy menstrual bleeding effectively and has no significant impact on ovarian function. 36 Embozenes microspheres (Varian, United States) are another type of tightly calibrated microsphere that can be used as an embolic agent.
校準微球是另一種在 UAE 中常用的栓塞劑。校準微球的優勢在于，與 PVA 不同，它們在尺寸上更加均勻，這導致栓塞更加可預測，并最小化了在 UAE 過程中使用的導管堵塞。在一項前瞻性多中心研究中，微球顯示出低的不良事件發生率，減少了子宮肌瘤體積，并改善了生活質量。在另一項前瞻性臨床試驗中，8Spheres（蘇州恒瑞凱瑞森生物醫藥技術，中國），一種符合性微球，已被證明可以有效緩解經量過多，并且對卵巢功能沒有顯著影響。Embozenes 微球（Varian，美國）是另一種可以用作栓塞劑的緊密校準微球。

Small-sized PVAs ranging between 100 and 300 μm were found to be safe and effective in treating adenomyosis in a study conducted by Yuan et al, 37 with an average follow-up of 42 months. They found no significant relationship between the clinical outcomes, the initial presence of adenomyosis, with or without fibroids, and the JZ thickness. 37
Yuan 等人在一項研究中發現，直徑在 100 至 300 微米之間的PVAs在治療腺肌癥方面安全有效，平均隨訪時間為 42 個月。他們發現，臨床結果與腺肌癥初始存在與否、有無子宮肌瘤以及 JZ 厚度之間沒有顯著關聯。

Regardless of type, embolic agents play an important role in the success of uterine artery embolization. Another important factor in the success of UAE is the determination of embolization end point strategy. Embolization with an endpoint of near stasis, as opposed to complete stasis, has been reported to result in less postprocedural pain. 38 It is now widely accepted that embolizing the uterine artery with a 5 to 10 heart-beat stasis is an adequate endpoint 39 ( Fig. 3 ).
無論類型如何，栓塞劑在子宮動脈栓塞術的成功中發揮著重要作用。UAE 成功的一個重要因素是確定栓塞終點策略。

與完全靜止相比，以近乎靜止為終點的栓塞已被報道可導致術后疼痛減輕。現在普遍認為，以 5 至 10 個心跳靜止為終點的子宮動脈栓塞是一個足夠的終點。

Fig. 3. 圖 3。

一名34歲的女性出現大量和長期的月經出血，盆腔疼痛和壓力癥狀。提供了只有子宮切除術作為一種治療選擇的時候，她進行了自己的研究后，來到我們的診所尋求照顧。

(a)UAE（子宮動脈栓塞術）前矢狀位T1加權脂肪飽和對比增強（CE）圖像顯示多發性增強肌瘤。(b)栓塞前左UA橫段（箭頭）的數字減影血管造影（DSA）顯示UA肥大和多發性肌瘤染色。(c)栓塞后左UA DSA顯示UA閉塞和宮頸-陰道分支通暢（箭頭）。(d)6個月隨訪CE MRI顯示子宮尺寸減小，肌瘤無增強，與囊性變性一致。在臨床隨訪期間，她表示重度、持續出血和大塊癥狀已消退。

其他一些病例

Periprocedural Pain Management
圍手術期疼痛管理

UAE can be associated with moderate to severe postprocedural pain, and effective pain management is important for patient comfort and satisfaction. Several studies have recently investigated the use of different pain management strategies after UAE. These strategies include preprocedural oral analgesics, local anesthesia, epidural patient-controlled analgesia, conscious sedation, and general anesthesia. 40
UAE 可能與術后中到重度疼痛相關，有效的疼痛管理對患者的舒適度和滿意度至關重要。（無痛治療對患者非常重要）

最近有幾項研究調查了 UAE 后使用不同的疼痛管理策略。這些策略包括術前口服鎮痛藥、局部麻醉、硬膜外患者自控鎮痛、鎮靜麻醉和全身麻醉。

Some interventional radiologists prefer administering pain medications before or during the UAE to minimize postprocedural pain. The combination of medications that can be administered is a loading dose of hydromorphone hydrochloride or nonsteroidal anti-inflammatory drugs (NSAIDs) and a patient-controlled analgesia. Ondansetron is the preferred antiemetic due to its effectiveness and tolerability. 39 This approach is also believed to avoid postembolization syndrome (PES), which will be discussed as one of the most common postprocedural complications after UAE for fibroids and adenomyosis.
一些介入放射科醫生更喜歡在 UAE 前后或期間給予止痛藥，以最大限度地減少術后疼痛?？梢越o予的藥物組合是鹽酸氫嗎啡酮或非甾體抗炎藥（NSAIDs）的負荷劑量以及患者控制的鎮痛。由于奧丹司瓊的有效性和耐受性，它是首選的抗惡心藥。 39 這種方法也被認為可以避免栓塞后綜合征（PES），這將在討論 UAE 治療子宮肌瘤和腺肌病后最常見的術后并發癥之一時進行討論。

A study from Katsumori et al 41 investigating intra-arterial lidocaine administration immediately after UAE with TAGM for leiomyoma was found to be safe. Still, it did not contribute to a significant reduction in pain or amount of narcotic agents administered. 41
一項由 Katsumori 等人進行的研究發現，在 UAE 后立即通過動脈內給予利多卡因治療子宮肌瘤是安全的。然而，它并沒有導致疼痛或使用的麻醉劑劑量的顯著減少。

Another approach gaining more popularity for periprocedural pain is superior hypogastric nerve block. Yoon et al 42 showed that superior hypogastric nerve block significantly decreased pain and nausea after uterine artery embolization as compared with a sham procedure.
另一種越來越受歡迎的圍手術期疼痛治療方法是高位腹下神經阻滯。Yoon 等人 42 的研究表明，與安慰劑手術相比，高位腹下神經阻滯顯著降低了子宮動脈栓塞術后的疼痛和惡心。

In a recent systematic review of post-UAE pain control regimens, the authors compared the average maximum pain scores of 26 studies that tested various medications, such as opioids, NSAIDs, acetaminophen, intra-arterial lidocaine, steroids, ketamine, or α2 adrenergic receptor agonists. After analyzing these groups' mean maximal pain scores, the authors concluded that there was no significant difference between them. Thus, they suggested that using opioids along with NSAIDs and acetaminophen may be sufficient in controlling post-UAE pain. 43
在最近的一項關于 UAE 術后疼痛控制方案的系統性綜述中，作者比較了 26 項研究測試的平均最大疼痛評分，這些研究測試了各種藥物，如阿片類藥物、非甾體抗炎藥、對乙酰氨基酚、動脈內利多卡因、類固醇、氯胺酮或α2 腎上腺素能受體激動劑。在分析這些組的平均最大疼痛評分后，作者得出結論，它們之間沒有顯著差異。因此，他們建議使用阿片類藥物與 NSAIDs 和對乙酰氨基酚聯合使用可能足以控制 UAE 術后疼痛。

Overall, the choice of pain management strategy after UAE should be individualized based on patient factors and preferences. Further research is needed to evaluate the benefits and risks of the different alternatives. Furthermore, providing detailed preprocedural counseling to patients regarding post-UAE pain timeline and severity can manage patient's expectations and reduce procedure-related anxiety.
總體而言，UAE 后疼痛管理策略的選擇應根據患者因素和偏好個性化。需要進一步研究以評估不同替代方案的利益和風險。此外，向患者提供有關 UAE 后疼痛時間表和嚴重程度的詳細術前咨詢，可以管理患者的期望并減少與手術相關的焦慮。

Postprocedural Care 術后護理

After undergoing UAE to treat fibroids and adenomyosis, most patients undergo a similar cascade of events referred to as PES. PES consists of pelvic pain, nausea, vomiting, and fever that start around 10 to 20 minutes after the procedure and usually peaks at around the eighth hour. 44 Diagnosis of PES can be difficult for non-interventionalists and may warrant further investigation to exclude other differentials like sepsis. 45 While it is not completely understood, the etiology of PES is believed to be due to the release of inflammatory mediators from tissue infarction after embolization. 46 One prospective study assessed that women who underwent UAE had a mean postprocedural score of 7/10 (±2.47) and an average hospital stay of 31.2 hours. 39 Many therapies have been tried to decrease postprocedural pain, such as intra-arterial lidocaine and steroids. A randomized prospective study showed that using intra-arterial lidocaine caused a significant reduction in the early hours of postprocedural pain. 47 Another study showed that administration of a single-dose intravenous infusion of dexamethasone decreased pain scores 12 hours after UAE as well as the incidence of nausea and vomiting. 48 After controlling the nausea and vomiting, the patient is discharged with narcotic agents to be taken on an as-needed basis. 39
經 UAE 治療子宮肌瘤和腺肌癥后，大多數患者會經歷被稱為 PES 的類似事件鏈。PES 包括盆腔疼痛、惡心、嘔吐和發熱，通常在手術后 10 至 20 分鐘開始，通常在第 8 小時左右達到高峰。

PES 的診斷對于非介入醫生來說可能很困難，可能需要進一步調查以排除其他不同病因，如敗血癥。雖然原因尚不完全清楚，但 PES 的病因被認為是由于栓塞后組織梗死釋放炎癥介質。一項前瞻性研究評估了接受 UAE 的婦女的平均術后評分為 7/10（±2.47），平均住院時間為 31.2 小時。許多治療方法已被嘗試以減少術后疼痛，如動脈內利多卡因和類固醇。一項隨機前瞻性研究顯示，使用動脈內利多卡因可顯著減少術后早期疼痛。 一項研究顯示，單劑量靜脈滴注地塞米松可降低 UAE 后 12 小時的疼痛評分，以及惡心和嘔吐的發生率?？刂茞盒暮蛧I吐后，患者帶用麻醉劑出院，按需服用。

Aside from PES, other complications, although rare, can also arise after UAE. Fibroid expulsions (FEs) are a late complication that may occur where the necrotic fragments of the fibroid are expulsed through the cervical canal. 45 Symptoms can include vaginal bleeding, cramping, and pelvic pain. Larger sloughed off fibroids can also cause a blockage at the cervical os, which could lead to infection. Certain factors predispose patients to FE, such as size and location of the tumor, with submucosal and transmural fibroids having the highest risk. 49 Pedunculated fibroids, while historically thought of as high risk, have a low risk of adverse events and FE; they can safely be treated with UAE. 14 The treatment of FE depends on a case-by-case basis, as most women tolerate FE well, with 50% needing no operative intervention. 50 While the rate of fibroid expulsion ranges from 1.7 to 50%, 50 it is still a serious complication that must be addressed. Another rare complication that may arise from UAE involves chronic vaginal discharge. While often asymptomatic, one study found vaginal discharge mixed with spherical particles from intramural and submucosal fibroids. 51
除 PES 外，其他并發癥雖然罕見，但在 UAE 后也可能發生。子宮肌瘤排出（FEs）是一種晚期并發癥，可能發生在肌瘤的壞死碎片通過宮頸管排出時。

癥狀可能包括陰道出血、痙攣和盆腔疼痛。較大的脫落的子宮肌瘤也可能導致宮頸口阻塞，這可能導致感染。某些因素使患者易患 FE，如腫瘤的大小和位置，黏膜下和穿透肌層的子宮肌瘤風險最高。

有蒂子宮肌瘤，雖然歷史上被認為是高風險，但不良事件和 FE 的風險較低；它們可以安全地通過 UAE 治療。FE 的治療取決于個案，因為大多數女性對 FE 的耐受性良好，其中 50%的女性不需要手術干預。盡管子宮肌瘤排出的發生率在 1.7%到 50%之間，但這仍然是一種嚴重的并發癥，必須加以解決。UAE 可能引起的另一種罕見并發癥是慢性陰道分泌物。雖然通常無癥狀，但一項研究發現，陰道分泌物中混合有來自肌層和黏膜下子宮肌瘤的球形顆粒。

Outcomes 結果

The outcomes of UAE on uterine fibroids are 50 to 60% fibroid size reduction, 88 to 92% reduction of bulk symptoms, greater than 90% elimination of uterine bleeding, and 75% elimination of symptoms. 52 The complications of UAE on uterine fibroids include 2 to 17% with prolonged vaginal discharge, 3 to 15% with fibroid expulsion, and 1 to 3% with septicemia according to SIR Standards of Practice Guidelines. 52 UAE has lower success with adenomyosis, where 76% of women had a resolution of symptoms. 53 Complications of UAE in adenomyosis are postprocedural pain in 87% of patients, persistent amenorrhea in 6 to 21% of patients, and need for hysterectomy in 14% of patients. 54
子宮肌瘤 UAE 治療的結果是 50 至 60%的肌瘤體積減小，88 至 92%的體積癥狀減輕，超過 90%的子宮出血消除，以及 75%的癥狀消除。 52

子宮肌瘤 UAE 治療的并發癥包括 2 至 17%的陰道分泌物延長，3 至 15%的肌瘤排出，以及 1 至 3%的敗血癥，根據 SIR 實踐指南標準。 52 UAE 在腺肌病治療中的成功率較低，其中 76%的女性癥狀得到緩解。 53 腺肌病中 UAE 的并發癥包括 87%的患者術后疼痛，6 至 21%的患者持續閉經，以及 14%的患者需要子宮切除術。 54

While the outcomes of UAE for both fibroids and adenomyosis are high, success also depends on the size of the embolic agent being used. According to one study, the use of only 500 to 700 μm particles resulted in a high rate of failed tumor infarction in uterine fibroids. 55 That same study showed that using 700- to 900-μm particles resulted in better imaging results and fewer repeat interventions. 55 TAGM particles can also be a great embolic agent for adenomyosis. One study showed that using microspheres ranging from 500 to 700 μm in size achieved a necrosis rate of 44.1%. 56
盡管 UAE 治療子宮肌瘤和腺肌癥的效果良好，但成功也取決于所使用的栓塞劑的大小。

根據一項研究，僅使用 500 至 700 微米的顆粒會導致子宮肌瘤腫瘤梗死失敗率較高。該研究還顯示，使用 700 至 900 微米的顆?？梢垣@得更好的成像結果和更少的重復干預。TAGM 顆粒也可以是腺肌癥的一個很好的栓塞劑。一項研究表明，使用 500 至 700 微米范圍的微球可以達到 44.1%的壞死率。

A recent deep learning-based study on predicting UAE outcomes found that there was no significant difference in UAE treatment response between fibroids' locations. 57 Similar to this finding, Firouznia et al 58 found that lesion location is not a factor in determining the clinical outcome of UAE. However, a study by Katsumori et al 59 showed that fibroid location within the uterus affects the likelihood of infarction after embolization. More specifically, they found that the anteriorly located fibroids and cervical fibroids have a lower infarction rate after UAE. The reasons for incomplete infarction of fibroids at these locations are unclear, but could be related to collateral arterial supply. One possible explanation for this phenomenon is that it may be linked to either the distribution of microspheres influenced by gravity during procedures performed while the patient is supine or hormonal changes resulting in shifts between watershed regions of the uterus, ovaries, or vagina based on the menstrual cycle phase. 60 The location of the fibroids is also important, as discussed earlier, due to the potential risk of expulsion. Sher et al 31 also found that submucosal location and pain are predictors of symptom recurrence.
近期一項基于深度學習預測 UAE 結果的研究發現，在纖維瘤的位置方面，UAE 治療反應沒有顯著差異。與這一發現相似，Firouznia 等人發現，病變位置不是決定 UAE 臨床結果的因素。

然而，Katsumori 等人的研究表明，子宮內纖維瘤的位置會影響栓塞后的梗死可能性。更具體地說，他們發現，位于前方的纖維瘤和宮頸纖維瘤在 UAE 后的梗死率較低。這些位置纖維瘤不完全梗死的原因尚不清楚，但可能與側支動脈供應有關。這種現象的一個可能解釋是，它可能與患者仰臥時手術過程中受重力影響的微球分布有關，或者與月經周期階段導致的子宮、卵巢或陰道分水嶺區域的變化有關。如前所述，纖維瘤的位置也很重要，因為存在排出的潛在風險。 Sher 等人 31 還發現，黏膜下位置和疼痛是癥狀復發的預測因素。

During the initial workup, the total volume and bulk of the fibroids are considered as part of the treatment decision making. Current evidence supports UAE as a safe and effective option to treat giant fibroids (volume ≥700 cc) causing bulk symptoms. However, the limited available data indicate a relatively higher risk of complications and reinterventions when compared with nongiant fibroids. Patients should be selected, counseled, and managed in a multidisciplinary fashion, as bulk symptoms take longer to improve after UAE. 61
在初步檢查過程中，子宮肌瘤的總體積和體積被視為治療決策的一部分?，F有證據支持 UAE（子宮動脈栓塞術）作為一種安全有效的治療巨大子宮肌瘤（體積≥700 cc）引起體積癥狀的選項。然而，有限的可獲得數據表明，與非巨大子宮肌瘤相比，UAE 的并發癥和再次干預的風險相對較高。患者應通過多學科方式選擇、咨詢和管理，因為 UAE 后體積癥狀的改善需要更長的時間。 61

While patients receive an extensive workup to rule out malignancy as described in the workup section, it may be difficult to differentiate leiomyoma from leiomyosarcoma on MRI. In a study that reviewed more than 300 patients who had follow-up after UAE, 4 were found to have leiomyosarcoma after UAE for presumed fibroids. 62 This study highlights that patients should be carefully assessed for underlying leiomyosarcoma and counseled accordingly.
在患者接受廣泛的檢查以排除惡性病變，如檢查部分所述的同時，在 MRI 上區分平滑肌瘤和平滑肌肉瘤可能很困難。在一項回顧了超過 300 名接受 UAE 術后隨訪的患者的研究中，發現有 4 名患者在 UAE 治療后被診斷為平滑肌肉瘤。 62 這項研究強調，應仔細評估患者是否存在潛在平滑肌肉瘤，并據此進行咨詢。

Fertility and UAE 生育與 UAE

Unlike hysterectomy, minimally invasive interventions such as UAE may help preserve fertility, especially in cases of symptomatic adenomyosis and large fibroids, according to recent studies. 63In fact, research indicates that even patients with larger uteri and fibroids greater than 10 cm do not experience significantly higher complication rates, suggesting that fibroid size should not be a contraindication for UAE.63However, one study found that miscarriage rates were highest in the UAE group compared to other minimally invasive techniques like HIFU and transcervical radiofrequency ablation.64Nonetheless, this study identified maternal age as a confounding variable that could have contributed to the odds of fetal and maternal complications.64Another systematic review was conducted on a cohort of 2,000 women, out of which 1,575 underwent myomectomies, while 424 underwent UAE, as reported by Zanolli et al.65The study revealed that the birth rate outcome was 60.6% for both UAE and myomectomies, compared to 75.6% for the latter. There was a higher rate of spontaneous abortion of 27.4% for the UAE, as opposed to 19.0% for myomectomies.65Again, the study indicated that the patients who underwent UAE were older and had smaller fibroids when compared to those who underwent laparoscopic myomectomy.65On the other hand, a meta-analysis of 189 patients, of which 44 became pregnant (23.3%) after UAE, found that the live birth rate was estimated to be 88.6% among patients aged 24.5 to 33 years, indicating that UAE does not significantly affect birth rates compared to the general population.66A meta-analysis by Jiang et al67investigated the overall pregnancy outcomes after uterus-sparing nonexcisional treatments such as UAE and ablation in patients with adenomyosis. Between January 2000 and 2022, 13 studies with 1,319 patients with adenomyosis were included. The pregnancy and miscarriage rates after nonexcisional treatments were 51 and 22%, respectively, without a statistically significant difference compared to adenomyosis excision outcomes. Overall, recent literature suggests that UAE on a young cohort does not have a negative impact on fertility or pregnancy outcomes when compared to the general population.
與子宮切除術不同，根據最近的研究，微創干預措施如 UAE 可能有助于保留生育能力，尤其是在有癥狀的腺肌癥和大型子宮肌瘤的情況下。

事實上，研究表明，即使子宮較大且子宮肌瘤大于 10 厘米的患者，并發癥發生率也并未顯著升高，這表明子宮肌瘤的大小不應成為 UAE 的禁忌癥。然而，一項研究發現，與 HIFU 和經宮頸射頻消融等微創技術相比，UAE 組的流產率最高。盡管如此，這項研究將母體年齡確定為可能影響胎兒和母體并發癥發生幾率的混雜變量。

Zanolli 等人對 2000 名女性進行了另一項系統綜述，其中 1575 名女性接受了子宮肌瘤切除術，而 424 名女性接受了 UAE。該研究顯示，UAE 和子宮肌瘤切除術的出生率結果均為 60.6%，而后者為 75.6%。

UAE 組的自然流產率較高，為 27.4%，而子宮肌瘤切除術組為 19.0%。 65

再次，該研究指出，與接受腹腔鏡子宮肌瘤切除術的患者相比，接受 UAE 的患者年齡較大，子宮肌瘤較小。 65

另一方面，一項對 189 名患者的薈萃分析，其中 44 名（23.3%）在 UAE 后懷孕，發現 24.5 至 33 歲年齡段的患者的活產率估計為 88.6%，表明與普通人群相比，UAE 對生育率沒有顯著影響。 66

Jiang 等人進行的一項薈萃分析研究了腺肌病患者接受子宮保留非切除性治療（如 UAE 和消融術）后的整體妊娠結果。從 2000 年 1 月到 2022 年，納入了 13 項研究，共涉及 1,319 名腺肌病患者。非切除性治療后的妊娠率和流產率分別為 51%和 22%，與腺肌病切除性治療結果相比，沒有統計學上的顯著差異?？偟膩碚f，近期文獻表明，與普通人群相比，UAE 對年輕人群的生育能力或妊娠結果沒有負面影響。

Conclusion 結論

Endovascular treatments are promising and effective for both adenomyosis and uterine fibroids. While traditional surgical approaches have been successful in the past, there was an increase in complications and longer hospital times associated with them. Endovascular treatments like uterine artery embolization are minimally invasive with very few complications. It is important to note that some patients prefer less invasive treatment options. Therefore, healthcare providers should provide comprehensive counseling on all available treatment options, which may include conservative, medical, minimally invasive, surgical, or a combination thereof, to help patients make informed decisions about their care. In conclusion, endovascular treatment is expected to play a more significant role as a management tool for both fibroids and adenomyosis in the future.
血管內治療對腺肌病和子宮肌瘤都很有希望且有效。雖然傳統的手術方法在過去已經取得了成功，但與之相關的并發癥增加和住院時間延長。

子宮動脈栓塞等血管內治療具有微創和并發癥極少的優點。需要注意的是，一些患者更喜歡侵入性較小的治療方案。因此，醫療保健提供者應提供關于所有可用治療方案的全面咨詢，這可能包括保守治療、藥物治療、微創治療、手術治療或其組合，以幫助患者就其護理做出明智的決定。

總之，預計血管內治療在未來作為纖維瘤和腺肌病的管理工具將發揮更重要的作用。

轉載自謝波介入

掃描上方二維碼碼加入知識星球，獲取更多腫瘤和介入醫學專業資料

目前已有380+腫瘤和介入醫療圈人員加入

知識星球介入相關資料（部分）

患者免費問診方式

一：微信掃碼關注網上診室，按下圖右方操作步驟填寫資料免費問診；

二：直接掃描下方二維碼或微信搜索doctorcuiwei或13392120659添加小崔哥個人私信進一步溝通。

抖音｜腫瘤介入小崔哥

（使用抖音 APP掃碼或 搜索：腫瘤介入小崔哥）

知乎｜介入小崔哥

（使用知乎 APP掃碼或 搜索：介入小崔哥）