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目的 探讨子宫肌瘤动脉栓塞术 (UAE)后的病理学变化。方法 1 999年 6月至 2 0 0 3年 1 0月对广州市第一人民医院 4 86例子宫肌瘤患者行UAE治疗 ,栓塞剂选择PVA或KMG颗粒 ,其中对 4 9例术后获取的肌瘤标本进行病理学观察。结果 UAE后坏死的肌瘤肉眼观早期呈紫黑色 ,中期呈黄白色 ,晚期呈黄色或金黄色 ,假包膜明显增厚 ,在妊娠期更加明显 ;不同直径的肌瘤UAE后在光镜下观察到的坏死时间不同 :直径 0 2～1 0cm、4 0～ 5 0cm、6 0～ 9 0cm及大于 1 0 0cm的肌瘤在UAE后分别于 1 4d、1 8h、1 2h和 6h可观察到明显的坏死 ;UAE后肌瘤、假包膜明显坏死而正常肌层未见明显坏死 ,假包膜内可见含铁血黄素沉积。结论 UAE可导致各种大小的肌瘤坏死 ,肌瘤坏死的时间与肌瘤的大小呈反比。
Objective To investigate the pathological changes of uterine fibroids after arterial embolization (UAE). METHODS: From June 1999 to January 2003, 486 patients with uterine fibroids in Guangzhou First People’s Hospital underwent UAE. The PVA or KMG particles were selected as embolic agents. Among them, 49 Fibroids specimens were pathologically observed. Results UAE necrotic fibroids were purple early in the macroscopic appearance, yellow-white in the middle, yellow or golden yellow in the later period, and the pseudocapsule was thicker and more obvious in pregnancy. After UAE with different diameters, The observed necrosis time was different: fibroids with diameters of 0 2 ~ 1 0cm, 4 0 ~ 5 0cm, 6 0 ~ 9 0cm and larger than 1 000cm were observed at 14d, 18h, 12h and 6h respectively after UAE To obvious necrosis; UAE after fibroids, pseudomembranous necrosis obvious necrosis and no obvious necrosis, pseudomedelay visible hemosiderin deposition. Conclusion UAE can lead to various sizes of fibroids necrosis, fibroids necrosis time and the size of the fibroids inversely proportional.