Uterine artery embolization
de Bruijn, A.M.
2019
document version
Publisher's PDF, also known as Version of record
Link to publication in VU Research Portal
citation for published version (APA)
de Bruijn, A. M. (2019). Uterine artery embolization: for fibroids and adenomyosis.
General rights
Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain
• You may freely distribute the URL identifying the publication in the public portal ?
Take down policy
If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
E-mail address:
SUMMARY
7KLVWKHVLVDLPHGWRSRVLWLRQXWHULQHDUWHU\HPEROL]DWLRQ8$(DVWUHDWPHQWRSWLRQ IRUXWHULQHÀEURLGVDQGDGHQRP\RVLV7KLVZDVSUHVHQWHGLQWZRSDUWVRIWKLVWKHVLV
PART I
7KLV SDUW RI WKLV WKHVLV HYDOXDWHG 8$( IRU XWHULQH ÀEURLGV ZKLFK KDV EHHQ DSSOLHGIRURYHU\HDUVRQHVWHSIXUWKHUE\ORRNLQJDWORQJWHUPRXWFRPHV LPSOHPHQWDWLRQLQWKH1HWKHUODQGVDQGLWVDSSOLFDWLRQVLQDQXQXVXDOLQGLFDWLRQ FHUYLFDOÀEURLGV,QRUGHUWREHDEOHWRFRXQVHOSDWLHQWVRQORQJWHUPRXWFRPHV FRXQVHOLQJ LQIRUPDWLRQ IRU J\QHFRORJLVW DQG VWLPXODWH LPSOHPHQWDWLRQ LQWR GDLO\SUDFWLFHWKH\HDUIROORZXSRI(00<WULDOSDWLHQWVZDVFRQGXFWHG,Q DGGLWLRQDQ8$(LPSOHPHQWDWLRQLQYHQWRU\DQGSUHIHUHQFHVWXG\ZDVVHWXSWR DVVHVVLPSOHPHQWDWLRQRI8$(DQGLQYHVWLJDWHWKHKDPSHULQJRIIDFWRUVIRUWKH DSSOLFDWLRQRI8$(6LQFHZHQRWLFHGWKDW8$(HIÀFDF\DQGVDIHW\LQSDWLHQWV ZLWKV\PSWRPDWLFFHUYLFDOORFDWHGÀEURLGVZHUHQRW\HWHYDOXDWHGDFDVHVHULHV ZDVSXEOLVKHGWRLQLWLDWHIXUWKHUUHVHDUFKDQGSRVVLEO\H[SDQGWKHWKHUDSHXWLF DSSOLFDELOLW\RI8$( PART II 7KLVSDUWRIWKHWKHVLVPDNHVWKHÀ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uality of Life after Embolization vs Hysterectomy in Adenomyosis 7KLVLVDUDQGRPL]HGFRQWUROOHGWULDOFRPSDULQJXWHULQHDUWHU\HPEROL]DWLRQDQG K\VWHUHFWRP\LQWKHWUHDWPHQWRISDWLHQWVZLWKV\PSWRPDWLFDGHQRP\RVLV7KLV WKHVLVGHVFULEHVWKHGHVLJQRIWKLVWULDO7KHRXWFRPHVDUHQRWSDUWRIWKLVWKHVLV WKHWULDOLVVWLOOUHFUXLWLQJ
'XULQJ WKH LQFOXVLRQ SHULRG RI WKH 48(67$ WULDO ZH QRWLFHG GLIÀFXOWLHV LQ GLDJQRVLQJDGHQRP\RVLV,WVHHPVDGHQRP\RVLVLVDIUHTXHQWO\XQUHFRJQL]HG EHQLJQGLVHDVHRUPLVWDNHQIRUXWHULQHÀEURLGGLVHDVH*\QHFRORJLVWVLQGLFDWHG ODFN RI NQRZOHGJH FRQFHUQLQJ WKH GLVHDVH LPDJLQJ FKDUDFWHULVWLFV DQG
SRVVLEOHWUHDWPHQWRSWLRQV6LQFHWUHDWPHQWPDQDJHPHQWLVRIWHQEDVHGRQDQ XOWUDVRQRJUDSKLFEDVHGGLDJQRVLVRIDGHQRP\RVLVRQO\DXQLIRUPUHSURGXFLEOH DQGFOLQLFDOO\UHOHYDQWUHSRUWLQJV\VWHPZDVGHYHORSHG
7KH DERYH PHQWLRQHG SHUIRUPHG VWXGLHV DV GHVFULEHG LQ WKLV WKHVLV ZLOO EH VXPPDUL]HGLQWKHQH[WSDUDJUDSKVWRJHWKHUZLOODJHQHUDOGLVFXVVLRQWKDW FRPSDUHVRXUUHVXOWVZLWKFXUUHQWOLWHUDWXUH7KHUHDIWHUWKHLPSOLFDWLRQRIWKLV WKHVLVZLOOEHPHQWLRQHGWRJHWKHUZLWKDQRYHUDOOFRQFOXVLRQDQGLQGLFDWLRQVIRU IXWXUHUHVHDUFK
RESULTS
MAIN FINDINGS PART I: UTERINE FIBROIDS
LONG TERM RESULTS OF UAE: THE RANDOMIZED EMMY TRIAL
IMPLEMENTATION OF UAE: AN INVENTORY AND PREFENRENCE STUDY
&KDSWHU GHVFULEHV DQ LQYHQWRU\ DQG SUHIHUHQFH VWXG\ WKDW DLPHG WR ÀQG RXWLIWKHQDWLRQDOJXLGHOLQHKDGDQ\HIIHFWRQ8$(LPSOHPHQWDWLRQDQG WRDVVHVVWKHGLIIHUHQWDVSHFWVRI8$(FRXQVHOLQJSUHIHUHQFHGLIÀFXOWLHVDQG NQRZOHGJHDZDUHQHVVDPRQJJ\QHFRORJLVWV,QRUGHUWRREVHUYHWKHTXDQWLW\ RISHUIRUPHG8$(LQWKH1HWKHUODQGVWKHDQGDQQXDOUHSRUWVRI DOOKRVSLWDOVZHUHUHTXHVWHGDQGXVHGWRHVWDEOLVKWKHRYHUDOO8$(K\VWHUHFWRP\ UDWLR6HFRQGO\TXHVWLRQQDLUHVZHUHÀOOHGLQE\J\QHFRORJLVWVZRUNLQJDW8$( SHUIRUPLQJ8$(DQGQRQ8$(SHUIRUPLQJ8$(KRVSLWDOVUHVXOWLQJLQDJURXS FRPSDULVRQDQDO\VLV7KH8$(K\VWHUHFWRP\UDWLREHIRUHDQGDIWHU LQFRUSRUDWLRQLQWKHJXLGHOLQHUHPDLQHGORZDQGZHUHDQG UHVSHFWLYHO\2XWFRPHVRIWKHTXHVWLRQQDLUHVÀOOHGLQE\J\QHFRORJLVWVVKRZHG WKDWWKHDYDLODELOLW\RI8$(LQÁXHQFHVWKHIUHTXHQF\DQGW\SHRIFRXQVHOLQJ LQSDWLHQWVZLWKV\PSWRPDWLFXWHULQHÀEURLGV8$(KRVSLWDOVHVWLPDWHKLJKHU FRXQVHOLQJ QXPEHUV FRPSDUHG WR 8$( KRVSLWDOV $SSUR[LPDWHO\ RI J\QHFRORJLVWVZRUNLQJLQ8$(KRVSLWDOVLQGLFDWHGWKDWWKH\KDYHLQVXIÀFLHQW LQIRUPDWLRQ DERXW 8$( IRU DSSURSULDWH FRXQVHOLQJ DQG LQ WKH PDMRULW\ RI J\QHFRORJLVWVIURPERWKKRVSLWDOVWKH\RYHUHVWLPDWHWKHULVNRIUHLQWHUYHQWLRQ :HFRQFOXGHGWKDWLWPLJKWEHXVHIXOWRGHYHORSDQRSWLRQJULGRUGHFLVLRQ PDNLQJWRROLQRUGHUWRRIIHULQGHSHQGHQWFRXQVHOLQJDQGHQFRXUDJHVKDUHG GHFLVLRQPDNLQJ
UAE IN THE TREATMENT OF CERVICAL FIBROIDS.
In FKDSWHUZHSHUIRUPHGDQHYDOXDWLRQRQVDIHW\DQGHIÀFDF\RIXWHULQH DUWHU\HPEROL]DWLRQ8$(LQWKHSDWLHQWVZLWKV\PSWRPDWLFFHUYLFDOÀ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ÀEURLGVLVHIIHFWLYHDQGVDIHZLWKVLJQLÀFDQW LPSURYHPHQWRIV\PSWRPVDQGTXDOLW\RIOLIH,WVHHPVDYDOXDEOHRSWLRQIRU ZRPHQVHHNLQJDQRQVXUJLFDOVROXWLRQRUZKHQRSHUDWLYHLQWHUYHQWLRQLVWRR GDQJHURXV
MAIN FINDINGS PART II: ADENOMYOSIS
7 YEAR FOLLOW-UP OF UAE IN PATIENTS WITH ADENOMYOSIS
In FKDSWHUZHDVVHVVHGFOLQLFDORXWFRPHVVHYHQ\HDUVDIWHUXWHULQHDUWHU\ HPEROL]DWLRQLQWKHWUHDWPHQWRIV\PSWRPVFDXVHGE\V\PSWRPDWLFDGHQRP\RVLV 7KHVHYHQ\HDUSRVWLQWHUYHQWLRQRXWFRPHVZHUHKHDOWKUHODWHGTXDOLW\RIOLIH +542/V\PSWRPVHYHULW\VFRUHV666SDWLHQWVDWLVIDFWLRQPHQRSDXVHDQGUH LQWHUYHQWLRQUDWHVZKLFKZHUHDVVHVVHGZLWKVWDQGDUGL]HGTXHVWLRQQDLUHV7ZHQW\ QLQHSDWLHQWVZLWKDGHQRP\RVLVLQFRPELQDWLRQZLWKÀEURLGVZHUHLQFOXGHG DQGWUHDWHGZLWK8$(EHWZHHQ6HSWHPEHUDQG-DQXDU\3UHYLRXVO\ UHVXOWVZHUHSXEOLVKHG\HDUVDIWHUWUHDWPHQW6HYHQ\HDUVDIWHUWUHDWPHQWRI SDWLHQWVKDGDVHFRQGDU\K\VWHUHFWRP\GXHWRSHUVLVWLQJFRPSODLQWV7KH LQLWLDOO\VLJQLÀFDQWO\LPSURYHG+542/DIWHU8$(UHPDLQHGVWDEOHWKURXJKRXWWKH \HDUVXSXQWRVHYHQ\HDUV7KH666VKRZHGDVPDOOVWDWLVWLFDOVLJQLÀFDQWGLIIHUHQFH LQIDYRURIWKHDGHQRP\RVLVLQFRPELQDWLRQZLWKÀEURLGVJURXSFRPSDUHGWRWKH SXUHDGHQRP\RVLVJURXS:HFRQFOXGHGWKDWLQRISDWLHQWV8$(UHVXOWVLQ SUHVHUYDWLRQRIWKHXWHUXVRISDWLHQWVDUHVDWLVÀHGDQGWZRWKLUGVHHPWR UHVSRQGZHOOWR8$(LQWHUPVRILPSURYHPHQWRI+542/DQG666
A SYSTEMATIC REVIEW AND METANALYSIS ON UAE IN THE TREATMENT OF ADENOMYSOSIS
QUESTA TRIAL STUDY PROTOCOL
In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
SONOGRAPHIC CLASSIFICATION AND REPORTING FOR ADENOMYOSIS.
&KDSWHUSUHVHQWVDXQLIRUPFODVVLÀFDWLRQDQGVWDQGDUGL]HGUHSRUWLQJV\VWHPRI XOWUDVRXQGÀQGLQJVRIDGHQRP\RVLVXVLQJWKH0RUSKRORJLFDO8WHUXV6RQRJUDSKLF $VVHVVPHQW086$FULWHULD7KLVFODVVLÀFDWLRQDQGUHSRUWLQJV\VWHPZDVEXLOW EDVHGRQDWKRURXJKGLVFXVVLRQDPRQJDOODXWKRUVLQFOXGLQJD'HOSKLSURFHGXUH 6HOHFWHGLPDJHVDQGYLGHRVRIW\SLFDOFDVHVRIWKHGLIIHUHQWPRUSKRORJLFDO YDULDWLRQVRIDGHQRP\RVLVZHUHXVHGLQWKHGHEDWHV 7KLVV\VWHPLQFOXGHVLGHQWLÀFDWLRQRIDGHQRP\RVLVEDVHGRQ086$FULWHULD GLVHDVHORFDWLRQFODVVLÀFDWLRQRIWKHOHVLRQVDVIRFDORUGLIIXVHSUHVHQFH RUDEVHQFHRILQWUDOHVLRQDOF\VWVP\RPHWULDOOD\HULQYROYHPHQWMXQFWLRQDO ]RQHP\RPHWULXPVHURVDOLQYROYHPHQWGLVHDVHH[WHQWDQGOHVLRQVL]H7KH SURSRVHGFODVVLÀFDWLRQPLJKWQHHGWREHDPHQGHGDIWHUH[WHUQDOYDOLGDWLRQDQG EDVHGRQWKHUHVXOWRIIXWXUHVWXGLHVHYDOXDWLQJWKHUHODWLRQEHWZHHQXOWUDVRXQG IHDWXUHVFOLQLFDOV\PSWRPVKLVWRORJLFDOÀQGLQJDQGSRVVLEO\DOVR05,ÀQGLQJV
GENERAL DISCUSSION
UAE IN THE TREATMENT OF FIBROIDS.V\PSWRPDWLFFHUYLFDOÀEURLGVZDVFRQGXFWHG:HFRQFOXGHGWKDW8$(LQWKHVH SDWLHQWVVHHPVHIIHFWLYHDQGVDIHZLWKVLJQLÀFDQWLPSURYHPHQWLQV\PSWRPVDQG TXDOLW\RIOLIHKRZHYHULWZDVDYHU\VPDOOVDPSOHVL]HQ &RPSDUHGWRWKH RQO\RWKHUVPDOOUHWURVSHFWLYHVWXG\ZHUHSRUWHGDKLJKHUVXFFHVVUDWHKRZHYHU WKH\GLGQRWXVHYDOLGDWHGTXHVWLRQQDLUHV7KHGLIIHUHQFHLQRXWFRPHPLJKWEH H[SODLQHGE\YDVFXODULW\YDULHW\VPDOOHUÀEURLGVDQGWKXVOHVVLQIDUFWLRQLQWKHLU SRSXODWLRQRUDGLIIHUHQWFDWKHWHUL]DWLRQWHFKQLTXH6LQFHRQO\WKHVHWZRUHSRUWV DUHDYDLODEOHLPSOHPHQWDWLRQRI8$(LQWKHWUHDWPHQWRIFHUYLFDOÀEURLGVLVWRR SUHOLPLQDU\/DUJHUKLJKTXDOLW\WULDOVVKRXOGLGHDOO\EHFRQGXFWHGWRFRQÀUP RXUUHVXOWV+RZHYHUWKLVFRQGLWLRQLVUDUHVRODUJHSURVSHFWLYHVWXGLHVLQWKH IXWXUHVHHPXQOLNHO\6LQFHVXUJHU\FDQEHULVN\ZLWKFHUYLFDOÀEURLGVZHKRSH RXUUHSRUWFRQWULEXWHGWRWDNLQJ8$(DVDWUHDWPHQWRSWLRQIRUWKHVHÀEURLGVLQWR DFFRXQW
UAE IN THE TREATMENT OF ADENOMYOSIS.
3XEOLFDWLRQVRQWKHUHVXOWVDIWHU8$(LQWKHWUHDWPHQWRIDGHQRP\RVLVLQFUHDVHG LQWKHODVW\HDUVEXWHYLGHQFHLVVWLOOOLPLWHG2QO\VPDOOXQFRQWUROOHGFDVH VHULHVZHUHDYDLODEOHZKHQZHVWDUWHGWKHHYDOXDWLRQRIWKH\HDUIROORZXSRI 8$(LQWKHWUHDWPHQWRISDWLHQWVZLWKV\PSWRPDWLFDGHQRP\RVLV7KHVHFDVH VHULHVVKRZHGVXEVWDQWLDOLPSURYHPHQWRIV\PSWRPVKHDY\PHQVWUXDOEOHHGLQJ G\VPHQRUUKHDDQGEXONUHODWHGV\PSWRPVDIWHU8$($FFRUGLQJWRWKHVH XQFRQWUROOHGVHULHVFOLQLFDOHIIHFWLYHQHVVGHÀQHGDVLPSURYHPHQWRIKHDY\ PHQVWUXDOEOHHGLQJG\VPHQRUUKHDDQGEXONUHODWHGV\PSWRPVDYHUDJHG 7KHORQJHVWIROORZXSDPRQJRQHRIWKHVHFDVHVHULHVZDVPRQWKV,WMXVWLÀHG WKHHYDOXDWLRQRIORQJHUIROORZXSDQGDVIDUDVZHDUHDZDUHRIRXUSURVSHFWLYH FRKRUWLVWKHORQJHVWIROORZXSDYDLODEOHVRIDU7KHPRVWQRWLFHDEOHLPSURYHPHQW RI+542/LQSDWLHQWVZLWKSXUHDGHQRP\RVLVDQGLQDGHQRP\RVLVZLWKÀEURLGV RFFXUUHGLQWKHÀUVWPRQWKVDIWHU8$(DQGUHPDLQHGVWDEOHRYHUWLPHZLWKRXW GLIIHUHQFHVEHWZHHQWKHWZRJURXSV$WIROORZXSWKHV\PSWRPVVHYHULW\VFRUH VKRZHGFRPSDUDEOHVWDEOHLPSURYHPHQWZLWKDVPDOOVWDWLVWLFDOGLIIHUHQFHLQ IDYRURIWKHDGHQRP\RVLVFRPELQHGZLWKÀEURLGVJURXSDWDQGPRQWKV 7KLVÀQGLQJLVFRQFRUGDQWZLWKRXUV\VWHPDWLFUHYLHZDQGPHWDDQDO\VLVEXW FRXOGDOVREHH[SODLQHGE\WKHLQLWLDOVHOHFWLRQELDVZKHUHSDWLHQWVZLWKSXUH DGHQRP\RVLVKDGZRUVHV\PSWRPVFRPSDUHGWRWKHSDWLHQWVZLWKDGHQRP\RVLV DQGÀEURLGV$WRWDORIÀYHSDWLHQWVXQGHUZHQWDVHFRQGDU\K\VWHUHFWRP\ )RXURIWKHVHÀYHSDWLHQWVKDGK\VWHUHFWRP\DIWHUWKHHDUOLHUUHSRUWHGPRQWK IROORZXSLQWHUYDO:KHQFRPSDULQJRXUUHVXOWVWRRWKHUORQJWHUPSURVSHFWLYH FRKRUWVZHQRWLFHGWKDW%DHDWDOUHSRUWHGRQO\RQHVHFRQGDU\K\VWHUHFWRP\ DWPRQWKVLQDWRWDOIROORZXSRIPRQWKV7KLVUDWHZDVQRWFRPSDUDEOHWR RXUVWXG\DQGFRXOGSRVVLEO\EHH[SODLQHGE\WKHVHOHFWHGJURXSRISDWLHQWV LQRXUVWXG\ZLWKSRVVLEO\ZRUVHEDVHOLQHV\PSWRPVDQGQRRWKHURSWLRQWKDQ DK\VWHUHFWRP\DQGDORQJHUIROORZXSWKDQDQ\RWKHUVWXG\LQZKLFKZH GHPRQVWUDWHWKDWHYHQDWDQGPRQWKVVHFRQGDU\K\VWHUHFWRPLHVDUH SHUIRUPHG$QRWKHUORQJWHUPIROORZXSVWXG\XVLQJYDOLGDWHGTXHVWLRQQDLUHV VKRZHGFRPSDUDEOHRXWFRPHVDWDIROORZXSRIPRQWKV 7KHFRQWLQXHGLQFUHDVHLQSDWLHQWVXQGHUJRLQJK\VWHUHFWRP\XQGHUOLQHVWKH LPSRUWDQFHRIORQJWHUPIROORZXS,WFRXOGSURYLGHLQVLJKWVIRUSUHGLFWLRQRI TXDOLW\RIOLIHUHFXUUHQFHRIV\PSWRPVFRVWVDQGSRVVLEO\FRXQVHOLQJRISDWLHQWV 'XULQJHYDOXDWLRQRIWKHSURVSHFWLYHFRKRUWIRUORQJWHUPWUHDWPHQWHIIHFWVRI8$( LQSDWLHQWVZLWKDGHQRP\RVLVZHV\VWHPDWLFDOO\VHDUFKHGWKHOLWHUDWXUHIRUPRUH XSWRGDWHSXEOLFDWLRQVDQGFRQGXFWHGDV\VWHPDWLFUHYLHZDQGPHWDDQDO\VLV ,QWKLVUHYLHZZHFRQFOXGHGWKDW8$(KDVIDYRUDEOHVKRUWWHUPDQGORQJ WHUPRXWFRPHVZKHWKHULWLVSHUIRUPHGIRUSXUHDGHQRP\RVLVRUDGHQRP\RVLVLQ FRPELQDWLRQZLWKÀEURLGV7KHLQFOXGHGVWXGLHVUHSRUWHGLPSURYHPHQWRIFOLQLFDO V\PSWRPVGHÀQHGDVLPSURYHPHQWRIKHDY\PHQVWUXDOEOHHGLQJG\VPHQRUUKHD DQG EXON UHODWHG V\PSWRPV LQ RI RI SDWLHQWV *UHDWHU -= WKLFNQHVV!PPDQGORZLQIDUFWLRQUDWHVKDYHEHHQDVVRFLDWHGZLWK GHFUHDVHGHIIHFWLYHQHVVIRU8$(LQWUHDWLQJDGHQRP\RVLV:KDWKDPSHUHGWKLV UHYLHZZDVWKHKHWHURJHQHLW\RIVWXGLHVQRDYDLODEOHUDQGRPL]HGFRQWUROOHG WULDOVVPDOOVDPSOHVL]HDQGXQGHUUHSRUWLQJRIH[FOXGHGSDWLHQWRUSDWLHQWVORVW WRIROORZXSWKHUHIRUHVHOHFWLRQELDVDQGSXEOLFDWLRQELDVFRXOGQRWEHUXOHG RXW,QDGGLWLRQQRYDOLGDWHGDGHQRP\RVLVVSHFLÀFTXHVWLRQQDLUHVDYDLODEOH $VDUHVXOWRIWKHVHOLPLWDWLRQVWKLVUHYLHZGRHVQRWVXSSRUWWRRVWURQJFOLQLFDO FRQFOXVLRQVUHJDUGLQJ8$(LQWKHWUHDWPHQWRIV\PSWRPDWLFDGHQRP\RVLV,W QHHGHGWREHFRQÀUPHGLQFRPSDUDWLYHSUHIHUDEO\UDQGRPL]HGWULDOVEHIRUH LPSOHPHQWDWLRQLQGDLO\SUDFWLFH
5HVXOWLQJLQWKHGHYHORSPHQWRIWKH48(67$4uality of Life after Embolization
vs Hysterectomy in Adenomyosis WR HYDOXDWH WKH WUXH HIIHFWLYHQHVV RI 8$(
LQFRPSDULVRQWRK\VWHUHFWRP\KRZHYHUGXULQJWKHLQFOXVLRQSHULRGSDWLHQW LQFOXVLRQ ZDV GLIÀFXOW ,W PRVWO\ VHHPHG KDPSHUHG E\ SRRU UHFRJQLWLRQ RI DGHQRP\RVLVRQXOWUDVRXQG7KHUHIRUHDXQLIRUPUHSURGXFLEOHDQGFOLQLFDOO\ UHOHYDQWUHSRUWLQJV\VWHPZDVGHYHORSHG
SONOGRAPHIC IMAGING IN DIAGNOSING ADENOMYOSIS
RIDUHFHQWFRQVHQVXVVWDWHPHQWGHVFULELQJWHUPVGHÀQLWLRQVDQGPHDVXUHPHQWV WKDWPD\EHXVHGLQWKHXOWUDVRQRJUDSKLFGHVFULSWLRQRIDGHQRP\RVLVWKHH[WHQW RIFULWHULDDQGPHWKRGVXVHGIRUGLDJQRVLQJDGHQRP\RVLVRQXOWUDVRQRJUDSK\ XVHG WR YDU\ EHWZHHQ VWXGLHV 7KLV FRQVHQVXV VWDWHPHQW LV D SRVLWLYH VWHS
WRZDUGDXQLÀHGQRPHQFODWXUHIRUUHVHDUFKDQGFODVVLÀFDWLRQLQDGHQRP\RVLV 1DIWDOLQ HW DO VKRZHG D JRRG OHYHO RI DJUHHPHQW EHWZHHQ KLVWRORJ\ DQG XOWUDVRQRJUDSKLFGLDJQRVLVRIDGHQRP\RVLVE\WKHXVHRIWKH086$FULWHULD KRZHYHUDOOXOWUDVRQRJUDSKLFGLDJQRVLVRIDGHQRP\RVLVZHUHGHWHUPLQHGE\ RQHVLQJOHRSHUDWRU6LQFHWKH086$FULWHULDKDYHQHYHUEHHQYDOLGDWHGLW ZDVUHDVRQDEOHWRDVVHVWKHXVHRIWKH086$FULWHULDE\WKHPHDQRIDQLQWUD LQWHUREVHUYHUVWXG\LQRUGHUDQGHVWDEOLVKWKHXVHRIWKHVHFULWHULDDVDUHOLDEOH PHWKRGIRUFOLQLFDOSUDFWLFH 6LQFHWKH086$FRQVHQVXVVWDWHPHQWGRHVQRWSURYLGHJXLGHOLQHVIRUKRZWR FODVVLI\PRUSKRORJLFDOW\SHVRUH[WHQWRIDGHQRP\RVLV7KHFODVVLÀFDWLRQDQG UHSRUWLQJV\VWHPDVGHVFULEHGLQWKLVWKHVLVZDVFRQGXFWHG,WVKRXOGIDFLOLWDWH FRQVLVWHQW UHSRUWLQJ DQG D JXLGHOLQH IRU FODVVLI\LQJ WKH DERYH PHQWLRQHG XOWUDVRQRJUDSKLFIHDWXUHV+RZHYHULWQHHGVWREHYDOLGDWHGDQGUHÀQHGDIWHU IXWXUHVWXGLHV6RPHLVVXHVKDYHULVHQGXULQJWKHGHYHORSPHQWRIWKHFODVVLÀFDWLRQ DQGUHSRUWLQJV\VWHPLQFOXGLQJUHVHDUFKLVQHHGHGWRDVVHVVWKHDFFXUDF\RI XOWUDVRXQGH[DPLQDWLRQLQWKHGLDJQRVLVRIIRFDOYHUVXVGLIIXVHDGHQRP\RVLV,Q DSURVSHFWLYHFDVHVHULHVDVVHVVLQJXWHULQHOHVLRQVLQK\VWHUHFWRP\VSHFLPHQV VRPHDGHQRP\RVLVOHVLRQVDSSHDUHGWREHPXFKPRUHH[WHQVLYHWKDQVXVSHFWHG DWXOWUDVRQRJUDSK\RURQPDFURVFRSLFH[DPLQDWLRQ7KHSRVVLELOLW\RIGLIIXVH GLVHDVHQRWGHWHFWHGDWXOWUDVRXQGH[DPLQDWLRQVKRXOGEHERUQLQPLQGZKHQ SODQQLQJ PDQDJHPHQW RI SDWLHQWV ZLWK DGHQRP\RVLV DQG ZKHQ SODQQLQJ VWXGLHVHYDOXDWLRQLIPRUSKRORJLFDOIHDWXUHVRIDGHQRP\RVLVLVDVVRFLDWHGZLWK FOLQLFDOV\PSWRPVDQGVXFFHVVRIIHUWLOLW\WUHDWPHQW6RPHUHFHQWVWXGLHVVHHP WRVKRZDQDVVRFLDWLRQKRZHYHUPRUHUHVHDUFKLVQHHGHGWRHYDOXDWHWKH LPSRUWDQFHRIHDFKRIWKHGLIIHUHQWXOWUDVRXQGIHDWXUHV7KHFODVVLÀFDWLRQZH KDYHVXJJHVWHGFDQQRWEHXVHGRQLWVRZQWRGHFLGHRQWUHDWPHQWEXWQHHGV WREHYDOLGDWHGÀUVW
FUTURE RESEARCH
7KH HPEROL]DWLRQ LPSOHPHQWDWLRQ SURFHVV WKH XVH DQG FRPSOLDQFH RI WKH KHDY\PHQVWUXDOEOHHGLQJJXLGHOLQHZDVWHVWHGE\WKHXVHRIHPEROL]DWLRQ K\VWHUHFWRP\UDWLR·VLQZRPHQZLWKV\PSWRPDWLFÀEURLGV,WVKRZVWKDWLWPLJKW EHXVHIXOWRGHYHORSDQRSWLRQJULGRUGHFLVLRQPDNLQJWRROLQRUGHUWRRIIHU LQGHSHQGHQWFRXQVHOLQJHQFRXUDJHVKDUHGGHFLVLRQPDNLQJDQGLQFUHDVH
LPSOHPHQWDWLRQ RI 8$( 7KLV HYDOXDWLRQ ZDV SDUW LQ WKH VRFDOOHG ¶FLUFOH RI TXDOLW\·¶NZDOLWHLWVFLUNHO LQ 'XWFK DV GHVLJQHG E\ WKH (00< WULDO JURXS )XUWKHUPRUHWKHJXLGHOLQHVKRXOGEHXSGDWHGZLWKWKHQHZHYLGHQFHRI8$( YHUVXVK\VWHUHFWRP\DIWHU\HDUV
,QWKLVWKHVLVZHGHVFULEHWKHVWLOORQJRLQJUDQGRPL]HGFRQWUROOHG48(67$WULDO 4uality of Life after Embolization vs Hysterectomy in Adenomyosis7KLVWULDOPLJKW HVWDEOLVKWKHUROHRI8$(LQZRPHQVXIIHULQJIURPV\PSWRPDWLFDGHQRP\RVLV %HVLGHVWKLVWKHUROHRI8$(DVZHOODVRWKHUPLQLPDOO\LQYDVLYHDOWHUQDWLYHVHJ 05J)86P\RPHFWRP\LQWKHWUHDWPHQWRIZRPHQWKDWKDYHDZLVKWRFRQFHLYH LQWKHIXWXUHGHVHUYHVWREHLQYHVWLJDWHG %HVLGHVLQYHVWLJDWLQJIXWXUHWUHDWPHQWRSWLRQVIRUDGHQRP\RVLVZHUHFRPPHQG WKHXVHRIWKHVWDQGDUGL]HG8)642/TXHVWLRQQDLUHLQDOOIXWXUHVWXGLHVWRKDYH FRQJUXRXVDQGFRPSDUDEOHRXWFRPHV)XWKHUPRUHGLDJQRVLQJDGHQRP\RVLV LVVWLOOFKDOOHQJLQJ:HSURSRVHGDXQLIRUPXOWUDVRQRJUDSKLFFODVVLÀFDWLRQDQG UHSRUWLQJV\VWHPLQGLDJQRVLQJDGHQRP\RVLV$IWHUYDOLGDWLRQDQGRSWLPL]DWLRQ RIWKHSURSRVHGFODVVLÀFDWLRQE\PHDQVRIDLQWHUDQGLQWUDREVHUYHUYDOLGDWLRQ VWXG\ LW ZRXOG EH UHDVRQDEOH WR GHYHORS DQ HOHDUQLQJ SURJUDP IRU OHVV H[SHULHQFHGXOWUDVRQRJUDSKHUV
)XUWKHUPRUH WKH FODVVLÀFDWLRQ DOVR QHHGV WR EH DPHQGHG DIWHU H[WHUQDO YDOLGDWLRQEDVHGRQWKHUHVXOWVRIIXWXUHVWXGLHVHYDOXDWLQJWKHUHODWLRQEHWZHHQ XOWUDVRXQGIHDWXUHVFOLQLFDOV\PSWRPVKLVWRORJLFDOÀQGLQJVDQGSRVVLEO\DOVR 05,ÀQGLQJV
CONCLUSION
8$(LQWKHWUHDWPHQWRIDGHQRP\RVLVVHHPVSURPLVLQJKRZHYHULWVWLOOKDVWREH FRQÀUPHGLQZHOOVHWXSDQGJRRGTXDOLW\WULDOVEHIRUHLPSOHPHQWDWLRQLQGDLO\ SUDFWLFH 8OWUDVRQRJUDSKLFGLDJQRVLVRIDGHQRP\RVLVVHHPVFKDOOHQJLQJGXHWRODFNRI WUDLQLQJDQGUHFRJQLWLRQRIWKHUHODWLYHO\QHZSXEOLVKHGFULWHULDIRUDGHQRP\RVLV 7KHXQLIRUPUHSRUWLQJDQGFODVVLÀFDWLRQV\VWHPDVGHVFULEHGLQWKLVWKHVLVVKRXOG VXSSRUWFRQVLVWHQWUHSRUWLQJ
REFERENCES
-+5DYLQD'+HUEUHWHDX1&LUDUX9LJQHURQ-0%RXUHW(+RXGDUW$$\PDUG DQG--0HUODQG$UWHULDOHPEROLVDWLRQWRWUHDWXWHULQHP\RPDWDLancet -.*XSWD$6LQKD0$/XPVGHQDQG0+LFNH\8WHULQHDUWHU\HPEROL]DWLRQIRU V\PSWRPDWLFXWHULQHÀEURLGVCochraneDatabaseSystRev &' $0GH%UXLMQ:0$QNXP-$5HHNHUV(%LUQLH60YDQGHU.RRLM1$9RONHUV DQG:-+HKHQNDPS8WHULQHDUWHU\HPEROL]DWLRQYVK\VWHUHFWRP\LQWKHWUHDWPHQW RIV\PSWRPDWLFXWHULQHÀEURLGV\HDURXWFRPHVIURPWKHUDQGRPL]HG(00<WULDO Am J Obstet Gynecol HH 1$9RONHUV:-+HKHQNDPS(%LUQLH:0$QNXPDQG-$5HHNHUV8WHULQHDUWHU\ HPEROL]DWLRQYHUVXVK\VWHUHFWRP\LQWKHWUHDWPHQWRIV\PSWRPDWLFXWHULQHÀEURLGV \HDUV·RXWFRPHIURPWKHUDQGRPL]HG(00<WULDOAmJObstetGynecol 60YDQGHU.RRLM:-+HKHQNDPS1$9RONHUV(%LUQLH:0$QNXPDQG-$ 5HHNHUV8WHULQHDUWHU\HPEROL]DWLRQYVK\VWHUHFWRP\LQWKHWUHDWPHQWRIV\PSWRPDWLF XWHULQHÀEURLGV\HDURXWFRPHIURPWKHUDQGRPL]HG(00<WULDOAmJObstetGynecol -*0RVV.*&RRSHU$.KDXQG/60XUUD\*'0XUUD\2:X/(&UDLJDQG 0$/XPVGHQ5DQGRPLVHGFRPSDULVRQRIXWHULQHDUWHU\HPEROLVDWLRQ8$(ZLWK VXUJLFDOWUHDWPHQWLQSDWLHQWVZLWKV\PSWRPDWLFXWHULQHÀEURLGV5(67WULDO\HDU UHVXOWVBJOG 60YDQGHU.RRLM(.OLQW:-+HKHQNDPS6%LSDW:0$QNXPDQG-$5HHNHUV ,PSOHPHQWDWLRQRIXWHULQHDUWHU\HPEROLVDWLRQIRUV\PSWRPDWLFXWHULQHÀEURLGVDQ LQYHQWRU\Neth J Med 192*+HDY\PHQVWUXDOEOHHGLQJ $0GH%UXLMQ+XLVPDQ-+HKHQNDPS-./RKOH3105HHNHU-$7LPPHUPDQV$ 7ZLMQVWUD$5+,PSOHPHQWDWLRQRIXWHULQHDUWHU\HPEROL]DWLRQIRUV\PSWRPDWLFÀEURLGV LQWKH1HWKHUODQGVDQLQYHQWRU\DQGSUHIHUHQFHVWXG\Cardiovascular interventional radiology $0$6609%UXLMQGH$+HKHQNDPS:-.6PHHWV$-/RSH]$+XLUQH-$)/RKOH 3108WHULQHDUWHU\HPEROL]DWLRQLQZRPHQZLWKV\PSWRPDWLFFHUYLFDOOHLRP\RPD HIÀFDF\DQGVDIHW\Journal of cardiovascular interventional radiology0'.LP0/HH'&-XQJ6,3DUN06/HH-<:RQ'</HHDQG.+/HH /LPLWHGHIÀFDF\RIXWHULQHDUWHU\HPEROL]DWLRQIRUFHUYLFDOOHLRP\RPDVJ Vasc Interv Radiol
0 3RSRYLF 6 3XFKQHU ' %HU]DF]\ - /DPPHU DQG 5 $ %XFHN 8WHULQH DUWHU\ HPEROL]DWLRQIRUWKHWUHDWPHQWRIDGHQRP\RVLVDUHYLHZJVascIntervRadiol
$0GH%UXLMQ06PLQN310/RKOH-$)+XLUQH-:57ZLVN&:RQJ/ 6FKRRQPDGHDQG:-.+HKHQNDPS8WHULQH$UWHU\(PEROL]DWLRQIRUWKH7UHDWPHQW RI$GHQRP\RVLV$6\VWHPDWLF5HYLHZDQG0HWD$QDO\VLVJ Vasc Interv Radiol H
9
O\
5-1LMHQKXLV$-6PHHWV00RUSXUJR3)%RHNNRRL3-5HXZHU06PLQN:- YDQ5RRLMDQG31/RKOH8WHULQHDUWHU\HPEROLVDWLRQIRUV\PSWRPDWLFDGHQRP\RVLV ZLWKSRO\]HQH)FRDWHGK\GURJHOPLFURVSKHUHVWKUHH\HDUFOLQLFDOIROORZXSXVLQJ 8)64R/TXHVWLRQQDLUHCardiovasc Intervent Radiol
6+%DH0'.LP*0.LP6-/HH6,3DUN-<:RQDQG</HHGR8WHULQH $UWHU\(PEROL]DWLRQIRU$GHQRP\RVLV3HUFHQWDJHRI1HFURVLV3UHGLFWV0LGWHUP&OLQLFDO 5HFXUUHQFHJ Vasc Interv Radiol H
9 )URHOLQJ & 6FKHXULJ0XHQNOHU % +DPP DQG 7 - .URHQFNH 8WHULQH DUWHU\ HPEROL]DWLRQ WR WUHDW XWHULQH DGHQRP\RVLV ZLWK RU ZLWKRXW XWHULQH OHLRP\RPDWD UHVXOWVRIV\PSWRPFRQWURODQGKHDOWKUHODWHGTXDOLW\RIOLIHPRQWKVDIWHUWUHDWPHQW Cardiovasc Intervent Radiol
5 . &XQQLQJKDP 0 0 +RUURZ 5 - 6PLWK DQG - 6SULQJHU $GHQRP\RVLV $ 6RQRJUDSKLF'LDJQRVLVRadiographics
-1DIWDOLQ:+RR11XQHV7+ROODQG'0DYUHORVDQG'-XUNRYLF$VVRFLDWLRQ EHWZHHQ XOWUDVRXQG IHDWXUHV RI DGHQRP\RVLV DQG VHYHULW\ RI PHQVWUXDO SDLQ Ultrasound Obstet Gynecol
79DQGHQ%RVFK0'XHKROP)3/HRQH/9DOHQWLQ&.5DVPXVVHQ$9RWLQR' 9DQ6FKRXEURHFN&/DQGROIR$-,QVWDOOH6*XHUULHUR&([DFRXVWRV6*RUGWV% %HQDFHUUDI7'·+RRJKH%'H0RRU+%UROPDQQ6*ROGVWHLQ((SVWHLQ7%RXUQHDQG '7LPPHUPDQ7HUPVGHÀQLWLRQVDQGPHDVXUHPHQWVWRGHVFULEHVRQRJUDSKLFIHDWXUHV RIP\RPHWULXPDQGXWHULQHPDVVHVDFRQVHQVXVRSLQLRQIURPWKH0RUSKRORJLFDO 8WHUXV6RQRJUDSKLF$VVHVVPHQW086$JURXSUltrasound Obstet Gynecol
79DQGHQ%RVFK$0GH%UXLMQ5$GH/HHXZ0'XHKROP&([DFRXVWRV/ 9DOHQWLQ7%RXUQH'7LPPHUPDQDQG-$)+XLUQH$VRQRJUDSKLFFODVVLÀFDWLRQ DQGUHSRUWLQJV\VWHPIRUGLDJQRVLQJDGHQRP\RVLVUltrasound Obstet Gynecol &$9DQGHUPHXOHQ/.MDHUJDDUG5DVPXVVHQ&7LPPHUPDQ'9DQGHQ%RVFK7 *XLGLQJKLVWRORJLFDODVVHVVPHQWRIXWHULQHOHVLRQVXVLQJ'LQYLWURXOWUDVRQRJUDSK\ DQGVWHUHRWD[LV/)DFWV9LHZV9LV2EJ\Q '0DYUHORV7.+ROODQG22·'RQRYDQ0.KDOLO*3ORXPSLGLV'-XUNRYLFDQG< .KDODI7KHLPSDFWRIDGHQRP\RVLVRQWKHRXWFRPHRI,9)HPEU\RWUDQVIHUReprod Biomed Online -1DIWDOLQ:+RR.3DWHPDQ'0DYUHORV;)RRDQG'-XUNRYLF,VDGHQRP\RVLV DVVRFLDWHGZLWKPHQRUUKDJLD"Hum Reprod