Vascular intervention treats gynecological diseases

Vascular intervention treats gynecological diseases. Uterine fibroids are the most common benign tumors in female organs, mainly formed by the proliferation of uterine smooth muscle cells. The exact etiology is still unclear.

Expert profile: Du Duanming, male, director of the Interventional Therapy Department, Shenzhen Second People’s Hospital (The First Affiliated Hospital of Shenzhen University), chief physician, professor, master tutor, and doctor of medicine from Peking University.

Interventional therapy is an emerging edge subject that combines medical imaging and clinical therapeutics that has been developed in the 1970s. Some scholars call it the third largest diagnosis and treatment technology alongside internal medicine and surgery. Due to its rapid development in the past ten years, interventional radiology has opened up new and effective treatment methods for many previously considered incurable or refractory clinically, and it is also increasingly playing an important role in the diagnosis and treatment of gynecological diseases.

1. Application of vascular interventional therapy in uterine fibroids

Uterine fibroids are the most common benign tumors in female organs, mainly formed by the proliferation of uterine smooth muscle cells. The exact etiology is still unclear. It mostly occurs in women aged 30-50, with an incidence rate of 20-25%. It is a common and frequently-occurring disease in women. Because many patients have no obvious symptoms, they are often ignored.

Uterine fibroids are very different in size. According to the relationship between their growth position and the layers of the uterine wall, they are divided into three categories: intramural fibroids, submucosal fibroids, and subserosal fibroids. Among them, intermural fibroids are the most common. It accounts for 60-70% of fibroids. The clinical manifestations of uterine fibroids often vary with the location, size, and growth rate of fibroids. Some patients have menstrual cycle changes, excessive menstrual flow, prolonged or shortened menstrual periods (about 2/3), and some patients have symptoms of compression and abdominal pain, and some patients have no discomfort. Even if the tumor has reached a certain size, it is still wrong It is believed that the weight gain caused the lower abdomen to bulge. The treatment of uterine fibroids can be determined according to the patient’s age, clinical symptoms, fibroids size, location, number, whether to retain fertility and other factors. Commonly used methods include follow-up observation, drug treatment and surgical treatment.

With the development of minimally invasive medicine, the application of interventional therapy in the treatment of uterine fibroids has received more and more attention. At present, interventional treatment of uterine fibroids has been widely used at home and abroad. Interventional therapy is to selectively place a catheter with a diameter of about 3mm through the femoral artery in the nutritional artery of the uterine fibroids, and inject embolic agents through the catheter to selectively embolize the blood supply artery of the fibroids. After the blood supply target artery is embolized, the fibroids tissue is avascular and necrotic, gradually absorbed, and the fibroids shrink significantly.

Advantages of interventional treatment of uterine fibroids:

1. The patient has little trauma, quick recovery, and almost no scars on the body surface after operation.

2. Good treatment effect.

3. Little systemic side effects and little damage to the uterus.

4. Less complications.

2: Application of vascular interventional therapy in gynecological malignant tumors

For the same reason, malignant tumors can also be treated with the same minimally invasive methods.

The most common gynecological malignant tumor is uterine cancer, and ovarian cancer ranks second. Others include malignant trophoblastoma, vaginal and vaginal cancer, and pelvic metastatic tumors. In the past, surgical procedures were mostly used for gynecological malignancies. Comprehensive methods such as chemotherapy and radiotherapy are used to relieve patients’ pain and prolong survival time. However, surgery is often unresectable due to widespread tumor pelvic metastasis, patients are poor in physique, immune function is low, and intravenous chemotherapy has a large systemic response, and it is often difficult to tolerate chemotherapy. Toxicity; large tumors, poor blood supply, insensitivity to radiotherapy and other reasons make radiotherapy less effective. In recent years, with the widespread application of interventional treatment of arterial regional infusion chemotherapy, the improvement of intubation methods, and the improvement of operating techniques, the clinical efficacy has been greatly improved. For those who cannot tolerate surgery or recurrence and metastasis after postoperative radiotherapy or chemotherapy and other Patients with gynecological malignancies whose treatment methods are ineffective provide the opportunity to continue treatment.

The basic method of interventional therapy is to puncture and intubate the right femoral artery, place the catheter selectively at the blood supply artery of the tumor, and locally inject chemotherapeutic drugs through the catheter for perfusion chemotherapy. At the same time, it can also embolize the tumor blood vessels and cause tumor ischemic necrosis. Compared with traditional methods, the local administration of interventional therapy can greatly increase the drug distribution in tumor tissues and reduce systemic side effects. The combined application of chemotherapy and embolization can further increase the local drug concentration and reduce side effects. Compared with surgery, intervention has the advantages of less trauma, complete under local anesthesia, simple postoperative care, and faster recovery.

Indications for interventional therapy:

1. There is a clear histopathological type and lesion range.

2. Adjuvant chemotherapy before and after surgery or radiotherapy for various gynecological malignancies.

3. Patients who are unable to undergo surgery or radiotherapy are undergoing surgery or radiotherapy after arterial infusion chemotherapy and embolization have reduced the tumor to a limited extent.

4. Patients with residual local cancer after surgery for gynecological malignant tumors and local recurrence after surgery or radiotherapy.

5. Metastatic lesions of gynecological malignancies.

6. Lesion with poor systemic administration effect.

7. It can be combined with systemic chemotherapy or radiotherapy for synergy and sensitization.

8. Those with normal liver, kidney, heart, lung, bone marrow and blood coagulation functions.

Contraindications of interventional therapy:

1. Elderly, frail and cachexia patients.

2. Those who are allergic to iodine and are not suitable for angiography.

3. Severe dysfunction of important organs.

4. Those who have infection and fever.

5. Those with severe anemia or bleeding tendency.

3: Application of vascular interventional therapy in tubal pregnancy

Tubal pregnancy is a common ectopic pregnancy in obstetrics and gynecology. The traditional treatment is to remove the fallopian tube by caesarean section. This not only brings pain to patients and increases their economic burden, but also reduces or loses the risk of re-pregnancy for patients with fertility requirements. opportunity. However, conservative treatment of drugs, a variety of intramuscular and intravenous injections of embryo-killing drugs has a long treatment course and large side effects.

The newly emerging interventional treatment of tubal pregnancy effectively avoids the above-mentioned shortcomings. The theoretical basis of interventional treatment of tubal pregnancy is that more than 85% of the blood supply of the fallopian tube comes from the uterine artery. The uterine artery is the main supply artery for the blastocyst of ectopic pregnancy in the fallopian tube. The basic method is to infuse the drug directly through the uterine artery and give it gelatin sponge particles. Uterine artery embolization has the advantages of:

1. The local drug concentration is very high. After the infusion is completed, the gelatin sponge particles are given to completely embolize the uterine artery, temporarily blocking the blood supply of the pregnancy sac, so that the villi attached to the wall of the fallopian tube will undergo rapid degeneration and necrosis in a short period of time, which can be quickly killed Embryo effect

2. Embolization of the uterine artery can prevent fatal hemorrhage caused by the rupture of the gestational sac, but it will not increase the risk of uterine ischemia and necrosis for ectopic pregnancy in the narrow part of the fallopian tube, the interstitial part, the horn of the uterus and the neck of the uterus.

3. The surgical approach is simple, minimally invasive, safe and simple to operate, simple postoperative care, quick recovery, and low cost.

(source:internet, reference only)

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