臨床婦人科産科68巻2号

2014年03月発行

今月の臨床 子宮筋腫―多様化した子宮温存療法

子宮温存療法の現況

5．子宮筋腫の子宮動脈塞栓術（UAE）

著者： 細井文子¹ 上田豊² 山本敏也¹ 木村正²

所属機関： ¹市立堺病院産婦人科 ²大阪大学大学院医学系研究科産科学婦人科学教室

ページ範囲：P.234 - P.240

文献概要

●UAEは筋腫に対する非観血的治療法であるが，施行に際しては適応と禁忌を十分に考慮する必要がある．

●治療効果は高率に得られ，長期間の効果の維持や術後の妊娠例も報告されているが，いまだ保険適用は得られていない．

●合併症には疼痛・塞栓後症候群・発熱・アレルギー・筋腫分娩・卵巣機能不全などがある．

参考文献

1） Ravina JH, Herbreteau D, Ciraru-Vigneron N, et al : Arterial embolisation to treat uterine myomata. Lancet 346 : 671―672, 1995

2） Abbara S, Nikolic B, Pelage JP, et al : Frequency and extent of uterine perfusion via ovarian arteries observed during uterine artery embolization for leiomyomas. AJR 188 : 1558―1563, 2007

3） Gabriel-Cox K, Jacobson GF, Armstrong MA, et al : Predictors of hysterectomy after uterine artery embolization for leiomyoma. AJOG 196 : 588. e1―6, 2007

4） Worthington-Kirsch R, Spies JB, Myers ER, et al : The Fibroid Registry for outcomes data（FIBROID） for uterine embolization : short-term outcomes. Obstet Gynecol 106 : 52―59, 2005

5） Burbank F, Hutchins FL Jr : Uterine Artery Occlusion by Embolization or Surgery for the Treatment of Fibroids : A Unifying Hypothesis-Transient Uterine Ischemia. J Am Assoc Gynecol Laparosc 7 : S1―S49, 2000

6） Society of Obstetricians and Gynaecologists of Canada : SOGC clinical practice guidelines. Uterine fibroid embolization（UFE）. Number 150, October 2004. Int J Gynaecol Obstet 89 : 305―318, 2005

7） Vashisht A, Studd J, Carey A, et al : Fatal septicaemia after fibroid embolisation. Lancet 354 : 307―308, 1999

8） de Blok S, de Vries C, Prinssen HM, et al : Fatal sepsis after uterine artery embolization with microspheres. J Vasc Interv Radiol 14 : 779―783, 2003

9） Spies JB, Spector A, Roth AR, et al : Complications after uterine artery embolization for leiomyomas. Obstet Gynecol 100 : 873―880, 2002

10） Godfrey CD, Zbella EA : Uterine necrosis after uterine artery embolization for leiomyoma. Obstet Gynecol 98 : 950―952 2001

11） Yeagley TJ, Goldberg J, Klein TA, et al : Labial necrosis after uterine artery embolization for leiomyomata. Obstet Gynecol 100 : 881―882, 2002

12） Sterling KM, Vogelzang RL, Chrisman HB, et al : V. Uterine fibroid embolization : management of complications. Tech Vasc Interv Radiol 5 : 56―66, 2002

13） El-Miligy M, Gordon A, Houston G, et al : Focal myometrial defect and partial placenta accreta in a pregnancy following bilateral uterine artery embolization. J Vasc Interv Radiol 18 : 789―791, 2007

14） Spies JB, Roth AR, Gonsalves SM, et al : Ovarian function after uterine artery embolization for leiomyomata : assessment with use of serum follicle stimulating hormone assay. J Vasc Interv Radiol 12 : 437―442, 2001

15） Bradley LD : Uterine fibroid embolization : a viable alternative to hysterectomy. Am J Obstet Gynecol 201 : 127―135, 2009

16） Goodwin SC, Spies JB, Worthington-Kirsch R, et al : Uterine artery embolization for treatment of leiomyomata : long-term outcomes from the FIBROID Registry. Obstet Gynecol 111 : 22―33, 2008

17） Hehenkamp WJ, Volkers NA, Broekmans FJ, et al : Loss of ovarian reserve after uterine artery embolization : a randomized comparison with hysterectomy. Hum Reprod 22 : 1996―2005, 2007

18） Fatal nontarget embolization via an intrafibroid arterial venous fistula during uterine fibroid embolization. J Vasc Interv Radiol 20 : 419―420, 2009

19） Czeyda-Pommersheim F, Magee ST, Cooper C, et al : Venous thromboembolism after uterine fibroid embolization. Cardiovasc Intervent Radiol 29 : 1136―1140, 2006

20） Hamoda H, Tait P, Edmonds DK : Fatal pulmonary embolus after uterine artery fibroid embolisation. Cardiovasc Intervent Radiol 32 : 1080―1082, 2009

21） Naguib NN, Mbalisike E, Nour-Eldin NE, et al : Leiomyoma volume changes at follow-up after uterine artery embolization : correlation with the initial leiomyoma volume and location. J Vasc Interv Radiol 21 : 490―495, 2010

22） Walker WJ, Pelage JP. : Uterine artery embolisation for symptomatic fibroids : clinical results in 400 women with imaging follow up. BJOG 109 : 1262―1272, 2002

23） Walker WJ, Barton-Smith P : Long-term follow up of uterine artery embolization-an effective alternative in the treatment of fibroids. BJOG 113 : 464―468, 2006

24） Toor SS, Jaberi A, Macdonald DB, et al : Complication rates and effectiveness of uterine artery embolization in the treatment of symptomatic leiomyomas : a systematic review and meta-analysis. AJR 199 : 1153―1163, 2012

25） Gupta JK, Sinha A, Lumsden MA, et al : Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev 5 : CD005073, 2006

26） Martin J, Bhanot K, Athreya S : Complications and reinterverntions in uterine artery embolization for symptomatic uterine fibroids : a literature review and meta analysis. Cardiovasc Intervent Radiol 36 : 395―402, 2013

27） Goldberg J, Pereira L, Berghella V, et al : Pregnancy outcomes after treatment for fibromyomata : uterine artery embolization versus laparoscopic myomectomy. Am J Obstet Gynecol 191 : 18―21, 2004

28） Homer H, Saridogan E : Uterine artery embolization for fibroids is associated with an increased risk of miscarriage. Fertil Steril 94 : 324―330, 2010

29） Yousefi S, Czeyda-Pommersheim F, White AM, et al : Repeat uterine artery embolization : indications and technical findings. J Vasc Interv Radiol 17 : 1923―1929, 2006