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Doctoral Thesis
DOI
10.11606/T.5.2007.tde-06062007-110430
Document
Author
Full name
Ricardo Augusto de Paula Pinto
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2007
Supervisor
Committee
Carnevale, Francisco Cesar (President)
Baracat, Edmund Chada
Bonduki, Claudio Emilio
Pastore, Ayrton Roberto
Teixeira Filho, Fábio Lopes
Title in Portuguese
Tratamento das pacientes sintomáticas portadoras de miomas uterinos através da associação das técnicas de embolização dos miomas e ligadura endovascular das artérias uterinas
Keywords in Portuguese
Álcool de polivinil
Analgesia controlada pela paciente
Artérias
Embolização terapêutica
Menorragia
Mioma/diagnóstico
Útero
Abstract in Portuguese
Os miomas uterinos são os tumores benignos mais comuns do trato genital feminino, sendo que nas mulheres portadoras, 30% são sintomáticos e exigem alguma forma de tratamento. No presente estudo, foram tratadas 35 pacientes sintomáticas com diagnóstico clínico e ultra-sonográfico de mioma uterino, por meio da embolização dos miomas com partículas de polivinil-álcool associadas à obstrução das artérias uterinas com micromolas fibradas. A avaliação clínica e ecográfica foram inicialmente feitas e o acompanhamento realizado após um, três, seis e doze meses do procedimento. O sucesso técnico foi de 94,3%. O volume uterino médio era de 404,53 cm3 antes do tratamento endovascular percutâneo e o sintoma mais freqüente, em 82,9%, a menorragia. A redução média dos volumes uterinos foi de 21,4%, 39,7%, 53,8% e 59,8% respectivamente em um, três, seis e 12 meses (p < 0,01). Houve, também, a redução do volume do nódulo miomatoso dominante em 5%, 18,5%, 26,8% e 32,9% em um, três, seis e 12 meses, respectivamente (p < 0,01). A melhora e o controle da menorragia foram obtidos em 100% das pacientes tratadas. Houve necessidade de histerectomia em uma paciente por insucesso no controle da dor após seis meses do procedimento. A embolização dos miomas uterinos com partículas de polivinil-álcool associada à oclusão endovascular das artérias uterinas com micromolas fibradas é uma alternativa de tratamento minimamente invasivo para as pacientes sintomáticas portadoras de miomas uterinos que proporciona controle e melhora dos sintomas e redução do tamanho dos miomas e do volume uterino.
Title in English
Uterine artery embolization with polyvinyl-alcohol particles and metallic coils for the treatment of symptomatic patients with fibroids
Keywords in English
Analgesia patient-controlled
Arteries
Embolization therapeutic
Menorrhagia
Myoma/diagnosis
Polyvinil alcohol
Uterus
Abstract in English
Uterine fibroids are the most frequent benign tumors of the female genital tract. The tumors are symptomatic in about 30% of the cases, requiring medical treatment. In the present study, a total of 35 clinically symptomatic patients with ultrasonographic diagnosis of fibroids underwent endovascular treatment, which consisted of embolization of the uterine arteries with 355-500 micras PVA particles associated to metallic coils. Clinical and ultrasonographic evaluations were performed at baseline, 1, 3, 6 and 12 months post-intervention. Technical success was obtained in 94.3% of the cases. Mean uterine volume before the procedure was 404.53 cm³ and menorrhagia was the most frequent symptom (82.9%). Mean reduction of the uterine volumes was 21.4%, 39.7%, 53.8% and 59.8% respectively at 1, 3, 6 and 12 months post-intervention. Dominant fibroid size was also significantly reduced after the procedure (5%, 18.5%, 26.8% and 32.9% reductions at 1, 3, 6 and 12 months, respectively; p < 0.01). Vaginal bleeding was abolished in all cases after the 12-month follow up. One patient needed to undergo hysterectomy 6 months after the procedure due to uncontrolled pain. Our results demonstrate uterine arteries embolization is minimally invasive and provides clinical control of the fibroids associated to significant reduction of the uterine volume. Moreover, the technique preserves the uterus and should be considered a therapeutic alternative to standard surgical treatment.
 
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Publishing Date
2007-07-02
 
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