Emergency embolization of pelvic vessels and uterine arteries in tumor bleeding in patients with cervical cancer (CC)

Abstract

Relevance. In the city of Shymkent and the Turkestan region, cervical cancer is diagnosed annually in 150-170 women. Of these, 28-30% of patients are diagnosed with the process at stage III-IV. In the process of seeking and treating patients with cervical cancer, 8-12% of patients experience tumor bleeding. Due to the widespread introduction of intravascular interventions in the clinic, the technique of arterial embolization of the uterine arteries and pelvic vessels for hemostasis is more often used. Purpose of the study. To assess the possibilities of emergency embolization of the uterine arteries and pelvic vessels for tumor bleeding in patients with cervical cancer. Materials and methods. Thirty patients aged 33 to 48 years were treated. All patients had stage IIa-IIIb of the process (T2N0M0 - T2-3bN1M0). All patients at the time of admission noted bloody discharge from the genital tract with clots, periodically the discharge had a profuse one-time nature. In the complete blood count, all patients had anemia of grade 2-3, hemoglobin in the blood fluctuated from 45 to 78 g / l, in 2 patients hemoglobin was 30-33 g / l. The time of admission to the hospital from the onset of bleeding was 24-72 hours. All patients, by decision of the council of doctors (oncogynecologist, surgeon, chemotherapist, interventional surgeon), urgently underwent mechanical embolization of the uterine arteries (5 cases) and embolization of the internal iliac arteries from the trunk of the UPA, the start time of emergency EMA from the moment of admission to the OOD was 1-1.5 hours. Metal spirals Gian-Turco and a hemostatic sponge were used as an embolizing material. Results and discussion. The analysis of immediate treatment results showed the effectiveness of the technique in all 30 patients (100%). The duration of the procedure is 25-40 minutes. The time it takes to stop bleeding from the start of the procedure when working with “four hands” (two vascular surgeons) is 7-15 minutes (depending on the anatomy of the UPA vessels). The effectiveness of mechanical hemostasis is 100%. The possibility of continuing special treatment is more than 80% of cases (mainly chemoradiation therapy). Pain relief was noted in 13 patients. During the follow-up examination after 1 month, stabilization of the process was noted in all patients. Chemoradiation therapy was performed, and 16 patients showed partial tumor regression with a decrease in the tumor node by 40-60% 2 months after special treatment. 24 patients successfully completed special treatment according to the selected chemoradiation therapy program. Of the complications, post-embolization syndrome was noted in 26 patients during the first 3-4 days, nausea and vomiting were observed in 15 patients, and grade 2 leukopenia was observed in 3 patients, which were stopped by conservative therapy. No serious complications associated with embolization were noted. Conclusion. The use of minimally invasive X-ray surgical methods of hemostasis in patients with cervical cancer complicated by bleeding allows achieving effective hemostasis in a short period of time, makes it possible to continue special treatment (chemo- and radiation therapy), improves the quality of life and increases the survival rate of patients; 80% of patients can complete special treatment.

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