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目的 探讨如何在介入法治疗子宫腺肌病中,有效减少子宫动脉栓塞术后疼痛。方法 将36 例根据临床症状、体征、超声及MR诊断为子宫腺肌病的患者分为两组,行选择性子宫动脉栓塞术。先用超液化碘油加平阳霉素(PYM)乳化后进行栓塞,再用明胶海绵栓塞子宫动脉主干。A 组术前肌注杜冷丁75 ~ 100mg、非那根25mg,栓塞前子宫动脉内注入利多卡因,采用低压流控法缓慢推注栓塞剂适量栓塞,栓塞剂用量为平阳霉素4 3~8mg(0.0163mg/cm3)、超液化碘油3 7~8ml(0 .0143ml/cm3),术后应用镇痛剂;B组仅术后对症应用镇痛剂,栓塞剂用量为平阳霉素8~16mg(0.0376mg/cm3)、超液化碘油4 7~10ml(0.0188ml/cm3)。观察病人疼痛程度,疼痛持续时间。结果 栓塞治疗后全部病例临床症状得到缓解,缓解率达100%。A 组与B 组无显著差异(P >0 05)。疼痛分级A、B两组分别为术中3. 05±0 .32、4 .81±0. 26,术后1 ~ 2 天2 .64±0 .12、4 .23±0 16 (P <0. 05);术后3~5天1 .73±0 .04、3 86±0 .08,术后5~14天0 .82±0 .24、3 .27±0. 65(P<0 .01)。结论 术前、术后应用镇痛剂,栓塞前注入利多卡因,注意采用低压流控法缓慢推注栓塞剂适量栓塞的综合措施,可有效减少子宫动脉栓塞术后的疼痛。
Objective To explore how to reduce the pain after uterine artery embolization in interventional therapy of adenomyosis. Methods Thirty - six patients diagnosed with adenomyosis according to clinical symptoms, signs, ultrasound and MR were divided into two groups and received selective uterine artery embolization. First with liquefied iodized oil plus Pingyangmycin (PYM) emulsified after embolization, and then embolization of uterine artery with gelatin sponge. A group of preoperative intramuscular injection of pethidine 75 ~ 100mg, non-root 25mg, uterine artery embolization before injection of lidocaine, low-pressure flow control bolus embolization appropriate embolization, embolization dose of pingyangmycin 43 ~ 8mg (0.0163mg / cm3), ultra-liquefied lipiodol 37 ~ 8ml (0.0143ml / cm3), after the application of analgesics; B group only postoperative symptomatic analgesics, the amount of embolizing agent Pingyangmycin 8 ~ 16mg (0.0376mg / cm3), ultra-liquefied lipiodol 47 ~ 10ml (0.0188ml / cm3). Observe the patient’s pain level and pain duration. Results After embolization, the clinical symptoms of all cases were relieved, and the response rate was 100%. There was no significant difference between group A and group B (P> 0.05). The pain scores of A and B groups were respectively 3. 05 ± 0.32, 4.81 ± 0.26 and 1 ~ 2 days after operation 2.64 ± 0.12 and 4.23 ± 0 16 (P < 0.05); 3 ~ 5 days after operation 1.73 ± 0.04,386 ± 0.08, 5 ~ 14 days after surgery 0.82 ± 0.24, 3.27 ± 0.65 (P < 0 .01). Conclusions Preoperative and postoperative analgesics, injection of lidocaine before embolization, attention to the use of low pressure flow control bolus embolization appropriate method of embolization a comprehensive measure can effectively reduce the pain after uterine artery embolization.