Uterin Fibroid Embolizasyon İşleminde Kullanılan Mikroküre Boyutunun Tedaviye Etkilerinin Retrospektif Analizi

Öz

Giriş: Uterin fibroidlerin tedavisinde altın standart yöntem minimal invaziv uterus koruyucu cerrahilerdir. Uterin fibroid embolizasyonu işlemi yaklaşık 20 yıldır uygulanmaktadır. Embolizan ajan olarak kullanılan mikroküre boyutlarının UFE tedavisine etkileri retrospektif olarak araştırılmıştır. Gereç ve Yöntemler: Retrospektif çalışmamızda UFE uygulanan 44 hastadan 500 Mikron ve altı boyutta mikroküreler ile tedaviye başlayan hastalar (Grup 1) ile 700 Mikron ve üstü mikroküre kullanılan hastaların (Grup 2) sonuçları karşılaştırıldı. Ağrı skorlaması, semptomlar ve dominant fibroid volümü işlem öncesi ve UFE sonrası 6. ay sonuçları karşılaştırıldı. Bulgular:Çok ciddi ağrı ve ciddi ağrı skorlayan hastaların sayısı Grup 1’de daha fazladır. Grup 1 ortalama ağrı skoru 4,9 iken Grup 2’de bu skor 3,6 bulundu(P<0,01). Hedef uterin fibroid hacimlerinde 6. ay MR tetkikinde iki grup karşılaştırıldığında ortalama hacim azalmaları benzer bulundu. Semptom giderilmesi oranlarında iki grup arasında fark saptanmadı. Tartışma: 6. ay MR tetkikleri karşılaştırıldığında dominant uterin fibroid boyutları her iki grupta da benzer şekilde azalmıştır. Uterus hacmindeki azalma açısından da anlamlı istatiksel farklılık saptanmadı. Mikroküre boyutu ile tedavi sonrası fibroid küçülmesi arasında anlamlı ilişki çalışmamızda saptanmadı. Ağrı ile partikül boyutları arasında ters orantılı bir ilişki mevcuttur. Küçük boyutlu mikroküre kullanımı ağrıyı arttırmaktadır. Semptomların giderilmesinde mikroküre boyutları ile ilişkili bulunmadı. Sonuç: Uterin fibroid embolizayonu işleminde kullanılan mikroküre boyutu ile klinik sonuçlar, semptomların giderilmesi arasında anlamlı bağlantı kurulamadı ancak işlem sonrası ağrı 500 mikron altında mikroküre kullanımı ile belirgin artış göstermiştir.

Anahtar Kelimeler

• Leiomyoma
• uterine artery embolization
• microspheres

Retrsopective analysis of microsphere’s size and effects on uterin fibroid embolization treatments

Öz

İntroduction: The gold standard method in the treatment of uterine fibroids is minimally invasive uterus-sparing surgery. Uterine fibroid embolization procedure has been practiced for about 20 years. The effects of microsphere sizes used as embolizing agents on UFE treatment were investigated in our retropective study. Materials and Methods: In our retrospective study, the results of 44 patients who underwent UFE investigated. We formed to 2 groups; Group 1 started to treatment with initial microspheres of 500 micron or less size and Group 2 patients who used microspheres of 700 micron and above as initial vial. The results of pain scoring, symptoms and dominant fibroid volume before the procedure and at 6 months after UFE were compared. Results: The number of patients scored very severe pain and severe pain was higher in Group 1. While the mean pain score in Group 1 was 4.9, it was 3.6 in Group 2 (P<0.01). When the two groups were compared in the 6th month MR examination in target uterine fibroid volumes, mean volume reductions were found to be similar. There was no difference between the two groups in symptom relief rates. Discussion: We compared the pretreatment and 6th month MRI examinations, we found the size of the dominant uterine fibroids decreased similarly in both groups; there is no statistically significant difference was found in terms of decrease in uterine volume. We did not found significant correlation between microsphere size and post-treatment fibroid shrinkage in our study. There is an inversely proportional relationship between pain and particle size. The use of small-sized microspheres increases pain. Microsphere sizes were not found to be associated with symptom relief. Conclusion: A significant correlation could not be established between the microsphere size and clinical results and symptom relief, but post-procedure pain increased significantly afeter the use of microspheres under 500 microns in the UFE procedures.

Anahtar Kelimeler

• Leiomyoma
• uterine artery embolization
• microspheres

Kaynakça

1. 1) Sohn GS, Cho S, Kim YM, Cho CH, Kim MR, Lee SR, Working Group of Society of Uterine Leiomyoma. Current medical treatment of uterine fbroids. Obstet Gynecol Sci. 2018;61(2):192–201.
2. 2)E. Downes, V. Sikirica, J. Gilabert-Estelles et al., “The burden of uterine fibroids in five European countries,” European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 152, no.1, pp. 96–102, 2010.
3. 3)S. Okolo, “Incidence, aetiology and epidemiology of uterine fibroids,” Best Practice & Research: Clinical Obstetrics & Gynaecology, vol. 22, no. 4, pp. 571–588, 2008.
4. 4)El-Balat A, DeWilde RL, Schmeil I, Tahmasbi-Rad M, Bogdanyova S, Fathi A, Becker S, Modern Myoma Treatment in the Last 20 Years: A Review of the Literature Biomed Res Int 2018 Jan 24;2018:4593875.
5. 5)Spies J, Allison S, Sterbis K, et al. Polyvinyl alcohol particles and trisacryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a randomized comparative study. J Vasc Interv Radiol. 2004; 15:793–800.
6. 6)Jiang W, Shen Z, Luo H, Hu X, Zhu X, Comparison of polyvinyl alcohol and tris-acryl gelatin microsphere materials in embolization for symptomatic leiomyomas: a systematic review. Minim Invasive Ther Allied Technol. 2016 Dec;25(6):289-300.
7. 7)Duvnjak S, Ravn P, Green A, Andersen PE, Uterine fibroid embolization with acrylamido polyvinyl microspheres: prospective 12-month clinical and MRI follow-up study, Acta Radiol. 2017 Aug;58(8):952-958.
8. 8)Olive DL, Lindheim SR, Pritts EA, Non-surgical management of leiomyoma: impact on fertility Curr Opin Obstet Gynecol. 2004 Jun;16(3):239-43.

9. 9)Siskin GP, Englander M, Stainken BF, Ahn J, Dowling K, Dolen EG. Embolic agents used for uterine leiomyoma embolization. AJR Am J Roentgenol 2000; 175:767–773.
10. 10)Yu SCH, Lok I, Ho SSY, Tong MMB, Hui JWY. Comparison of Clinical Outcomes of Tris-acryl Microspheres Versus Polyvinyl Alcohol Microspheres for Uterine Artery Embolization for Leiomyomas: Results of a Randomized Trial. J Vasc Interv Radiol 2011; 22:1229-1235.
11. 11)Chua GC, Wilsher M, Young MP, Manyonda I, Morgan R, Belli AM. Comparison of particle penetration with non-spherical polyvinyl alcohol versus trisacryl gelatin microspheres in women undergoing pre-myomectomy uterine artery embolization. Clin Radiol 2005; 60:116–212.
12. 12)Siskin GP, Beck A, Schuster M, Mandato K, Englander M, Herr DA. Leiomyoma Infarction after Uterine Artery Embolization: A Prospective Randomized Study Comparing Tris-acryl Gelatin Microspheres versus Polyvinyl Alcohol Microspheres. J Vasc Interv Radiol 2008; 19: 58-65.
13. 13)Shlansky-Goldberg RD, Rosen MA, Mondschein JI, Stavropoulos SW, Trerotola SO, Diaz-Cartelle J, Comparison of Polyvinyl Alcohol Microspheres and Tris-Acryl Gelatin Microspheres for Uterine Fibroid Embolization: Results of a Single-Center Randomized Study. J Vasc Interv Radiol 2014; 25:823–832.
14. 14)Liaw JVP, Yun C-H, Walker TG, Kalva SP, Janne d'Othée B, Comparison of clinical and MR imaging outcomes after uterine fibroid embolization with Bead Block and Embosphere Eur J Radiol. 2012 Jun;81(6):1371-1375.
15. 15)Bilhim T, Pisco JM, Duarte M, Oliveira AG, Polyvinyl Alcohol Particle Size for Uterine Artery Embolization: A Prospective Randomized Study of Initial Use of 350 –500M Particles versus Initial Use of 500 –700 M Particles J Vasc Interv Radiol 2011; 22:21–27.