经血管栓塞治疗可以缓解骨盆充血症状


  April 5, 2005 (纽奥良) - 一项于放射科医学会(SIR)第30届年会上的发表指出,女性因为卵巢及骨盆静脉曲张所引起的慢性骨盆疼痛,亦即骨盆充血,可以利用导管作经血管栓塞治疗而受益。
  
  约翰霍普金斯医学院的放射医学副教授H.S. Kevin Kim医师表示,该项疗法在临床上对于85%的女性患者作出明显的改善;其中的80%表示,他们的症状持续舒缓了4年。
  
  在SIR的记者会中,Kim医师指出,静脉曲张不但会导致下肢疼痛,也会发生在骨盆内,导致骨盆疼痛;有将近40%的女性在其一生中的某一阶段,会因为骨盆疼痛而抱怨;妇科门诊中,有10%的就诊原因即是骨盆疼痛;腹腔镜手术中,有三分之一是用来评估慢性骨盆疼痛。
  
  Kim医师表示,标准症状,包含骨盆腔会有负重或满涨的感觉,小孩出生以后,疼痛感会加剧。
  
  本项研究召募了131位女性患者,平均年龄为34岁,皆以静脉照影的方式作过骨盆充血的评估;其中有127位为骨盆充血的确定例,皆以导管穿透法进行经血管栓塞治疗;这些女性患者中,有37%为多产妇女,有20%接受过子宫切除手术,但是骨盆的疼痛程度却没有降低;有40位女性在试验前进行了腹腔镜评估,只有16位确定为骨盆充血;其它的70位以核磁共振造影作检查,41位确定为骨盆充血。
  
  Kim医师指出,值得注意的是,腹腔镜结果为阴性的患者,在经过治疗后,可以获得稍高的疼痛缓解程度;这个现象传达了一项讯息,在评估慢性骨盆疼痛时,静脉造影应该视为一个「黄金标准」。
  
  疼痛的评估以目视疼痛评分表及制式问卷进行,经血管栓塞治疗过后,平均的疼痛指数由基线的7.6(0到10刻度)进步到2.9;Kim表示,这是非常明显的改善。
  
  经血管栓塞治疗后,大部分的女性(80%),在许多项目上皆表示有著明显的改善,包含站立时的疼痛程度、性交时的疼痛感、频尿的状况及月经疼痛等;在一为期45个月的追踪期中,有4位女性企图受孕,其中有两位成功并于足月生产。
  
  SIR第30届年会:摘要159,2005年4月4日发表。

Embolotherapy Provides Durable

By Peggy Peck
Medscape Medical News

April 5, 2005 (New Orleans) — Women with chronic pelvic pain caused by the presence of ovarian and pelvic varicose veins — pelvic congestion — may benefit from transcatheter embolotherapy, according to research reported here yesterday at the Society of Interventional Radiology (SIR) 30th annual meeting.

H. S. Kevin Kim, MD, an assistant professor of radiology from Johns Hopkins University School of Medicine in Baltimore, Maryland, and lead author of the study, said "85% of women had significant clinical improvement with treatment, and 80% said they had durable lessening of pain for almost four years."

At an SIR press conference, Dr. Kim said, "Just as varicose veins can cause pain in the lower extremities, they can exist in the pelvic area and be the cause of pelvic pain." He added that as many as 40% of women may complain of pelvic pain at some time during their lives, and "it is estimated that 10% of visits to gynecologists are due to pelvic pain and as many as a third of laparoscopic procedures are done to assess chronic pelvic pain."

Typical symptoms include "heaviness or fullness in the pelvic area and pain may increase after childbirth," Dr. Kim said.

The study recruited 131 women, mean age of 34 years, who were assessed for pelvic congestion by venography. Pelvic congestion was confirmed in 127 women, who were treated with transcatheter embolotherapy. Thirty-seven percent of these women were multiparous. Hysterectomy had been performed on 20% of the women with no reduction in pelvic pain. Forty of the women had undergone laparoscopic assessments before the study, but only 16 of those women had positive findings for pelvic congestion. Another 70 women were assessed by magnetic resonance imaging, and the imaging studies were positive for pelvic congestion in 41 women.

"Of note, the women who had negative findings on laparoscopy had marginally better pain relief with treatment," Dr. Kim said. "The message here is that venography should be considered the 'gold standard' for evaluating chronic pelvic pain."

Pain was assessed with a visual analog scale and structured questionnaires. After treatment, mean pain scores improved from 7.6 (0-10 scale) at baseline to 2.9 after embolotherapy, which was highly significant (P < .000001).

After embolotherapy, most women (80%) also reported significant improvement in symptoms such as pain on standing, dyspareunia, urinary frequency, and menstrual pain (P < .0001). During a mean follow-up of 45 months, four women have attempted pregnancy and two have had successful, full-term pregnancies.

SIR 30th Annual Meeting: Abstract 159. Presented April 4, 2005.

Reviewed by Gary D. Vogin, MD

    
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