UAE治疗子宫肌瘤对女性卵巢功能的影响及 短期疗效观察

Impact of Uterine Artery Embolization on Ovarian Function and Observation of Short-Term Clinical Outcomes in Women with Uterine Fibroids

摘要: 目的：探讨子宫动脉栓塞术(uterine artery embolization, UAE)治疗子宫肌瘤后患者短期卵巢功能变化及肌瘤体积变化。方法：回顾性纳入2024年6月至2024年12月于青岛大学附属烟台毓璜顶医院接受UAE治疗并完成随访的84例绝经前子宫肌瘤患者。分别于术前及术后1个月、3个月、6个月月经周期第2~4天检测促卵泡生成激素(follicle-stimulating hormone, FSH)、促黄体生成激素(luteinizing hormone, LH)、雌二醇(estradiol, E₂)、抗缪勒管激素(anti-Müllerian hormone, AMH)及FSH/LH比值；术后6个月复查超声及MRI评估肌瘤体积。肌瘤体积分析以肌瘤个数为统计单位，共纳入252枚肌瘤。结果：84例患者共168条子宫动脉均成功插管，技术成功率为100%。与术前比较，术后1个月、3个月及6个月FSH及FSH/LH比值均升高，LH及E₂均降低，差异均有统计学意义(均P < 0.05)；术后不同时间点间上述指标比较差异均无统计学意义(均P > 0.05)。AMH在术前与术后各时间点以及术后不同时间点之间比较差异均无统计学意义。年龄分层描述性分析显示，40岁以上患者术后FSH及FSH/LH比值升高幅度相对更大，LH及E₂下降幅度相对更明显，而AMH整体未见持续下降趋势。按病灶直径分组后，中肌瘤组和大肌瘤组术后6个月体积较术前缩小，平均缩小率分别为(51.00% ± 30.19%)和(56.64% ± 17.66%)；小肌瘤组体积变化差异无统计学意义。结论：在本研究随访范围内，UAE在短期内可有效缩小子宫肌瘤体积，尤其对直径 ≥ 3 cm病灶疗效较为明确；同时，其对短期卵巢储备功能未见明确不利影响，但可伴有一定卵巢内分泌波动。临床上应结合患者年龄、基础卵巢功能及保宫需求，做好术前评估和术后随访。

Abstract: Objective: To investigate short-term changes in ovarian function and fibroid volume in women with uterine fibroids after uterine artery embolization (UAE). Methods: A retrospective analysis was conducted in 84 premenopausal women with uterine fibroids who underwent UAE and completed follow-up at Yantai Yuhuangding Hospital Affiliated to Qingdao University from June 2024 to December 2024. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E₂), anti-Müllerian hormone (AMH), and the FSH/LH ratio were measured on days 2~4 of the menstrual cycle before treatment and on days 2~4 of the menstrual cycle at the first, third, and sixth postoperative months. Ultrasonography and magnetic resonance imaging were repeated at the sixth postoperative month to evaluate fibroid volume. Fibroid volume analysis was performed using the number of fibroids as the statistical unit, and a total of 252 fibroids were included. Results: All 168 uterine arteries in the 84 patients were successfully catheterized, with a technical success rate of 100%. Compared with preoperative levels, FSH and the FSH/LH ratio increased, whereas LH and E₂ decreased at the first, third, and sixth postoperative months, and the differences were statistically significant (all P < 0.05). There were no statistically significant differences in these indices among postoperative time points (all P > 0.05). There were no statistically significant differences in AMH between preoperative and postoperative time points or among postoperative time points. Age-stratified descriptive analysis showed that patients older than 40 years had relatively greater increases in FSH and the FSH/LH ratio and relatively more marked decreases in LH and E₂ after treatment, while no sustained downward trend in AMH was observed overall. After stratification by lesion diameter, fibroid volume in the medium- and large-fibroid groups decreased at the sixth postoperative month, with mean shrinkage rates of 51.00% ± 30.19% and 56.64% ± 17.66%, respectively, whereas no statistically significant change in volume was observed in the small-fibroid group. Conclusion: Within the follow-up period of this study, UAE effectively reduced fibroid volume in the short term, particularly for lesions with a diameter of ≥3 cm. Meanwhile, no definite adverse effect on short-term ovarian reserve function was observed, although some ovarian endocrine fluctuations may occur. In clinical practice, preoperative evaluation and postoperative follow-up should be conducted according to patient age, baseline ovarian function, and uterine preservation needs.