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What are the advantages and disadvantages of vascular interventional therapy in gynecology

Time:2022-12-08 07:31:58 source:psychiatricethics.com author:Public activities Read:523次
What are the advantages and disadvantages of vascular interventional therapy in gynecology

As people's requirements for medical quality are getting higher and higher, minimally invasive has become a direction and a demand. Since the 1990s, interventional therapy has been applied to the field of obstetrics and gynecology. Relevant data show that in a tertiary hospital, one out of every 10 patients who use interventional therapy is an obstetrics and gynecology patient. However, in the impression of many patients, apart from the term "minimally invasive", people seem to have little understanding of the essence of this technology, so that it is difficult to make a choice in treatment options. Now, let's unravel its mystery.

Minimally invasive and precise

Interventional therapy is performed in Under the guidance of X-ray machine and conventional X-ray machine, etc.), specific instruments are introduced into human diseased parts for treatment through tiny wounds or human cavities. In the application of obstetrics and gynecology, it only needs to open a rice-grain-sized wound at the root of the thigh to accurately treat the lesion. How does it do it? The blood supply to the pelvic organs such as the ovaries, uterus, and fallopian tubes comes from the internal iliac artery. During the operation, the doctor pierced the femoral artery with a puncture needle at the superficial point of the femoral artery 0.5 cm below the groin, and inserted a guide wire along the puncture needle. At this time, with the help of contrast agents and imaging equipment, the doctor can observe the course of the blood vessels and the position of the guide wire, and guide the guide wire to pass through each blood vessel, through the femoral artery, external iliac artery, abdominal aorta, internal iliac artery in turn. Arteries, to the uterus, ovarian arteries, and finally to the blood vessels near the lesion. Then, according to the thickness of the blood vessels and the distribution of the lesions, an appropriate amount of embolic agent is selected to embolize the blood vessels. After embolization, the nutritional source of the diseased tissue is cut off, resulting in ischemia, necrosis, atrophy, and absorption, which can not only eliminate the lesions, but also preserve the reproductive organs. Similarly, anticancer drugs can also be directly injected into the tumor, so that the tumor has a high drug concentration and the therapeutic effect of the chemotherapeutic drugs is improved. Therefore, vascular interventional therapy has less trauma, accurate positioning and high curative effect.

Benign disease·tumor

Vascular interventional therapy is mainly used in three types of diseases in obstetrics and gynecology: one is advanced gynecological tumors, such as ovarian cancer, cervical cancer, and unresectable cancers that have metastasized to the pelvis and lymph nodes. Through interventional therapy, symptoms can be alleviated, the quality of life of the patient can be improved, the tumor can be reduced, and the chance of a second surgical resection can be increased. Second, common gynecological diseases, such as uterine fibroids, endometriosis, tubal obstruction, adenomyosis and so on. Through interventional treatment, the uterus can be preserved, and the patient's body recovers quickly after the operation, and usually can be discharged within 3 to 5 days. The third is emergency surgery in obstetrics and gynecology, such as postpartum hemorrhage, ectopic pregnancy and other situations that require hysterectomy, through interventional treatment, life can be saved and the uterus can be preserved. In addition to severe heart, lung, kidney dysfunction and coagulation dysfunction can not use interventional therapy, it is suitable for any other patients. In addition, the operation risk is small, the damage is small, and the safety is high. The 128-year-old Ms. Zhang was found to be incisional pregnancy (that is, the embryo implanted in the tiny gap of the uterine incision scar after cesarean section) when she was more than 2 months pregnant, and she was about to terminate the pregnancy. During the hysterectomy, massive bleeding occurred, and the obstetrician and gynecologist performed uterine vascular interventional surgery to block the arteries of the uterus and stop the bleeding in time. With conventional therapy, the uterus will be removed. Case 232-year-old Ms. Deng suffered from poor uterine contractions after cesarean section, postpartum hemorrhage, and exudate in the abdominal cavity. The situation is very critical. In order to reduce bleeding and exudation and avoid hysterectomy, the obstetrician and gynecologist used interventional therapy, which not only kept Ms. Deng out of danger, but also avoided hysterectomy.

Disadvantages·Complications

As with any treatment method and approach, interventional therapy also has its inherent drawbacks. The biggest advantage of interventional therapy is that it does not require surgery. However, for some benign gynecological diseases, such as uterine fibroids and adenomyosis, the possibility of malignant lesions cannot be ruled out because the tissue cannot be obtained for pathological diagnosis during the treatment process. Interventional therapy mainly achieves the therapeutic effect by embolizing the blood vessels of the lesion, but the pain caused by the expulsion of the necrotic lesion from the body cannot be avoided. Different from laparotomy, persistent or intermittent lower abdominal pain occurs 3 to 5 days after intervention, and some patients are combined with lumbosacral soreness and swelling, anal bulge, etc. Uterine fibroids) have gradually worsening paroxysmal lower abdominal pain before the discharge, and the pain disappears after the discharge; a small number of patients with adenomyosis have severe lower abdominal pain during the menstrual cycle 1 to 2 after the operation, which may be more severe than before the operation Heavy. The length of the patient's pain time varies depending on the surgical method, the choice and dosage of embolic agents, the size and location of the tumor, and the degree of embolization, and is related to the patient's age and constitution. In addition, the following complications may also occur: irregular vaginal bleeding, mainly caused by necrosis and shedding of endometrial or submucosal lesions after embolization; increased vaginal secretions, caused by liquefaction of necrotic endometrial or lesion tissue in the uterine cavity and discharged through the vagina It is caused by concurrent infection; oligomenorrhea and amenorrhea are caused by ischemic damage to the endometrium or ovary, and most patients are temporary and reversible. Ectopic embolism leading to organ damage, nerve damage, infection, pulmonary embolism, and obstruction and displacement of chemical kit catheters are less common. Some patients have tumor necrosis after surgery, and a large amount of necrotic tissue is discharged from the vagina, causing retrograde bacterial infection, resulting in uterine infection and necrosis that have to be removed, which is a rare and serious complication.

FAQs & Answers

Q1. Does the fluoroscopy equipment used in interventional surgery have radiation? Is it harmful to the patient? A: The fluoroscopy equipment during interventional treatment does produce radiation, but the amount of radiation is within the safe dose range. As long as the patient is not planning to become pregnant during pregnancy or within half a year, it is generally harmless. Q2: How long is the interventional treatment usually? A: The time required for different diseases is different, but it is generally shorter than traditional laparotomy. Q3: What should patients pay attention to? A: Young women should be cautious when choosing this method, as there may be adverse consequences due to accidental injury to the ovary or premature ovarian failure. Q4: What should patients pay attention to after interventional surgery? A: After surgery, the patient's puncture point should be compressed for 6 hours to avoid local bleeding. 24 hours of bed rest, during which time, pay attention to the fluctuation of blood pressure.

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