Dzemdes artēriju embolizācija kā dzemdes miomu ārstēšanas metode: trīs gadu retrospektīvs pētījums
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Latvijas Universitāte
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lav
Abstract
Dzemdes miomas ir viena no biežākajām labdabīgajām ginekoloģiskajām patoloģijām sievietēm reproduktīvajā vecumā, kas var būt saistītas ar ievērojamu simptomu slogu un dzīves kvalitātes pasliktināšanos. Mūsdienās līdztekus ķirurģiskām ārstēšanas metodēm pieaug interese par dzemdes saglabājošām, minimāli invazīvām pieejām, tostarp dzemdes artēriju embolizāciju (UAE). Šī procedūra pārtrauc asinsriti miomas audiem, izraisot to regresiju, vienlaikus saglabājot dzemdes integritāti. Pētījuma mērķis bija izvērtēt UAE efektivitāti dzemdes miomu ārstēšanā, analizējot pacientu demogrāfiskos un klīniskos datus, miomu raksturojumu, ārstēšanas izvēli un rezultātus. Pētījums veikts kā retrospektīva analīze reģionālā ārstniecības iestādē, ietverot 116 pacientes, kurām no 2022. līdz 2024. gadam veikta UAE, miomektomija vai histerektomija. Rezultāti parādīja, ka 90,3 % pacientēm pēc UAE nebija nepieciešama turpmāka invazīva ārstēšana. Statistiski nozīmīga saistība tika konstatēta starp miomas lokalizāciju un simptomiem: intramurālas miomas visbiežāk izraisīja menorāģiju (p < 0,001), submukozas – anēmiju (p = 0,006), bet subserozas – polimenoreju (p = 0,009). ĶMI bija zemāks UAE grupā nekā histerektomijas grupā (p = 0,012), un dzemdes saglabājošas metodes biežāk tika piemērotas jaunākām pacientēm (p < 0,001). Komplikācijas pēc UAE tika novērotas 22,6 % gadījumu, galvenokārt postembolizācijas sindroma formā. Sūdzības pēc ārstēšanas biežāk tika reģistrētas UAE grupā (p = 0,011). Secinājumi norāda, ka UAE ir efektīva, dzemdi saglabājoša ārstēšanas metode lielākajai daļai pacientēm, taču pacientu atlasei jābūt rūpīgi izvērtētai, ņemot vērā simptomus, miomas īpašības un auglības vēlmes.
Uterine fibroids are among the most common benign gynaecological conditions in women of reproductive age, often associated with a significant symptom burden and impaired quality of life. In addition to surgical treatment methods, there is a growing interest in uterus-preserving, minimally invasive approaches, including uterine artery embolization (UAE). This procedure disrupts the blood supply to fibroid tissue, leading to regression while preserving uterine integrity. The aim of this study was to evaluate the effectiveness of UAE in the treatment of uterine fibroids by analysing patient’s demographic and clinical characteristics, fibroid features, treatment choices, and outcomes. The study was conducted as a retrospective analysis at a regional healthcare facility, including 116 patients who underwent UAE, myomectomy, or hysterectomy between 2022 and 2024. Results showed that 90.3% of patients did not require further invasive treatment after UAE. A statistically significant association was found between fibroid location and symptoms: intramural fibroids were most commonly associated with menorrhagia (p < 0.001), submucosal fibroids with anaemia (p = 0.006), and subserosal fibroids with polymenorrhea (p = 0.009). BMI was significantly lower in the UAE group compared to the hysterectomy group (p = 0.012), and uterus-preserving treatments were more frequently chosen for younger patients (p < 0.001). Post-procedural complications were observed in 22.6% of cases, mostly as postembolization syndrome. Complaints following treatment were more commonly reported in the UAE group (p = 0.011). In conclusion, UAE is an effective uterus-preserving treatment option for the majority of patients; however, careful patient selection is essential, taking into account symptoms, fibroid characteristics, and fertility considerations.
Uterine fibroids are among the most common benign gynaecological conditions in women of reproductive age, often associated with a significant symptom burden and impaired quality of life. In addition to surgical treatment methods, there is a growing interest in uterus-preserving, minimally invasive approaches, including uterine artery embolization (UAE). This procedure disrupts the blood supply to fibroid tissue, leading to regression while preserving uterine integrity. The aim of this study was to evaluate the effectiveness of UAE in the treatment of uterine fibroids by analysing patient’s demographic and clinical characteristics, fibroid features, treatment choices, and outcomes. The study was conducted as a retrospective analysis at a regional healthcare facility, including 116 patients who underwent UAE, myomectomy, or hysterectomy between 2022 and 2024. Results showed that 90.3% of patients did not require further invasive treatment after UAE. A statistically significant association was found between fibroid location and symptoms: intramural fibroids were most commonly associated with menorrhagia (p < 0.001), submucosal fibroids with anaemia (p = 0.006), and subserosal fibroids with polymenorrhea (p = 0.009). BMI was significantly lower in the UAE group compared to the hysterectomy group (p = 0.012), and uterus-preserving treatments were more frequently chosen for younger patients (p < 0.001). Post-procedural complications were observed in 22.6% of cases, mostly as postembolization syndrome. Complaints following treatment were more commonly reported in the UAE group (p = 0.011). In conclusion, UAE is an effective uterus-preserving treatment option for the majority of patients; however, careful patient selection is essential, taking into account symptoms, fibroid characteristics, and fertility considerations.