射频消融治疗子宫肌瘤的疗效及机制探讨
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摘要
目的探讨妇科多功能射频治疗仪(BBT)治疗子宫肌瘤的指征、局限性、及影响即时手术疗效的因素。
方法62例子宫肌瘤患者,按肌瘤大小、数目、类型、宫腔深度、子宫位置、患者年龄分别分类。分析它们与手术前后肌瘤体积变化的关系。
结果不同体积、类型、宫腔深度的肌瘤,手术前后比较,差异有统计学意义(P<0.05)。体积＜35cm3的肌瘤治疗效果优于体积>35cm3的肌瘤(P＜0.05)；粘膜下肌瘤疗效优于浆膜下和肌壁间肌瘤,组间有统计学差异(P＜0.05)；其余因素则与肌瘤体积变化无关。
结论通过对影响BBT治疗子宫肌瘤的相关因素分析,认为这是一种微创、安全、有效的方法,明确了其适应症,为临床应用及疗效预测提供指导。
目的探讨射频消融治疗子宫肌瘤的局限性、影响手术疗效的相关因素及其治疗机制。
方法采用妇科多功能射频治疗仪(BBT)消融子宫肌瘤,62例子宫肌瘤患者,按肌瘤大小、数目、类型、子宫位置、宫腔深度、患者年龄分别分类,分析它们与手术时间及术中出血量的关系及手术前后B超、肌瘤光镜、电镜下病理变化。
结果肌瘤大小与手术时间相关(P＜0.05),各组间有统计学差异(P＜0.05)。肌瘤类型与术中出血量相关(P＜0.05),组间有统计学差异(P＜0.05),但与手术时间无关。而其余因素则与手术时间、术中出血量无关。射频消融后瘤体缩小变硬,镜下发生凝固性坏死；B超示术后回声减低甚至消失,可有钙化阴影。
结论射频消融是通过使肌瘤发生凝固性坏死来达到治疗目的的一种微创、安全、有效的方法,为临床应用及疗效预测提供指导。
Objective To evaluate the indications, limitations, and the factors related to recent operative efficacy of radio-frequency caloric ablation therapy (BBT).
Methods A total of 62 patients with uterine fibroid were treated with BBT. All the operations were done by one surgeon. We evaluated the correlations of different numbers, type, the length of uterine cavity, uterus position and patient's age with the change of uterine fibroids volume. The uterine fibroids were divided into several groups according to the factors metioned.
Results For uterine fibroids of different volume, types, uterine cavity, there is a significant difference before and after the BBT, for the different volume, less than 35 cm3 myomas volume shrink much more than the ones more than 35 cm3, the significant difference exist(P<0.05), significant difference exist indifferent types (P＜0.05), submucous myoma has the best recent operative efficacy.No significant difference exist between other factors and the change of uterine fibroids volume
Conclusions Our primary results indicate that radio-frequency caloric ablation therapy (BBT) is a less invasive, safe and useful technique. And the experiment provide a guide for clinical doctors and can give a clear predict for its efficacy.
Objective To evaluate the indications, limitations, and the factors related to operative efficacy and mechanism of radio-frequency caloric ablation therapy (BBT).
Methods A total of 62 patients with uterine fibroids(72 uterine fibroids in total)were treated with BBT. All the operations were done by one surgeon. We investigated the correlations of different diameters, numbers, types, the lengths of uterine cavity, uterus positions, patient's ages with operative duration and blood loss and the pathological changes after radio-frequency caloric ablation therapy. The uterine fibroids were divided into several groups according to the factors we metioned.
Results There is a correlation between uterine fibroids size and operative duration (P＜0.05), For different types of uterine fibroids there is a correlation with the blood loss,but no correlation with operative duration,There is no correlation with the number, the length of uterine cavity, uterus position and patient's age.Uterus myoma has irreversible necrosis and degeneration after ablation.
Conclusions Our primary results indicate that radio-frequency caloric ablation therapy (BBT) is a less invasive, safe and useful technique which though irreversible necrosis and degeneration. And the experiment provide a guide for clinical doctors and can give a clear predict for its efficacy.
方法62例子宫肌瘤患者,按肌瘤大小、数目、类型、宫腔深度、子宫位置、患者年龄分别分类。分析它们与手术前后肌瘤体积变化的关系。
结果不同体积、类型、宫腔深度的肌瘤,手术前后比较,差异有统计学意义(P<0.05)。体积＜35cm3的肌瘤治疗效果优于体积>35cm3的肌瘤(P＜0.05)；粘膜下肌瘤疗效优于浆膜下和肌壁间肌瘤,组间有统计学差异(P＜0.05)；其余因素则与肌瘤体积变化无关。
结论通过对影响BBT治疗子宫肌瘤的相关因素分析,认为这是一种微创、安全、有效的方法,明确了其适应症,为临床应用及疗效预测提供指导。
目的探讨射频消融治疗子宫肌瘤的局限性、影响手术疗效的相关因素及其治疗机制。
方法采用妇科多功能射频治疗仪(BBT)消融子宫肌瘤,62例子宫肌瘤患者,按肌瘤大小、数目、类型、子宫位置、宫腔深度、患者年龄分别分类,分析它们与手术时间及术中出血量的关系及手术前后B超、肌瘤光镜、电镜下病理变化。
结果肌瘤大小与手术时间相关(P＜0.05),各组间有统计学差异(P＜0.05)。肌瘤类型与术中出血量相关(P＜0.05),组间有统计学差异(P＜0.05),但与手术时间无关。而其余因素则与手术时间、术中出血量无关。射频消融后瘤体缩小变硬,镜下发生凝固性坏死；B超示术后回声减低甚至消失,可有钙化阴影。
结论射频消融是通过使肌瘤发生凝固性坏死来达到治疗目的的一种微创、安全、有效的方法,为临床应用及疗效预测提供指导。
Objective To evaluate the indications, limitations, and the factors related to recent operative efficacy of radio-frequency caloric ablation therapy (BBT).
Methods A total of 62 patients with uterine fibroid were treated with BBT. All the operations were done by one surgeon. We evaluated the correlations of different numbers, type, the length of uterine cavity, uterus position and patient's age with the change of uterine fibroids volume. The uterine fibroids were divided into several groups according to the factors metioned.
Results For uterine fibroids of different volume, types, uterine cavity, there is a significant difference before and after the BBT, for the different volume, less than 35 cm3 myomas volume shrink much more than the ones more than 35 cm3, the significant difference exist(P<0.05), significant difference exist indifferent types (P＜0.05), submucous myoma has the best recent operative efficacy.No significant difference exist between other factors and the change of uterine fibroids volume
Conclusions Our primary results indicate that radio-frequency caloric ablation therapy (BBT) is a less invasive, safe and useful technique. And the experiment provide a guide for clinical doctors and can give a clear predict for its efficacy.
Objective To evaluate the indications, limitations, and the factors related to operative efficacy and mechanism of radio-frequency caloric ablation therapy (BBT).
Methods A total of 62 patients with uterine fibroids(72 uterine fibroids in total)were treated with BBT. All the operations were done by one surgeon. We investigated the correlations of different diameters, numbers, types, the lengths of uterine cavity, uterus positions, patient's ages with operative duration and blood loss and the pathological changes after radio-frequency caloric ablation therapy. The uterine fibroids were divided into several groups according to the factors we metioned.
Results There is a correlation between uterine fibroids size and operative duration (P＜0.05), For different types of uterine fibroids there is a correlation with the blood loss,but no correlation with operative duration,There is no correlation with the number, the length of uterine cavity, uterus position and patient's age.Uterus myoma has irreversible necrosis and degeneration after ablation.
Conclusions Our primary results indicate that radio-frequency caloric ablation therapy (BBT) is a less invasive, safe and useful technique which though irreversible necrosis and degeneration. And the experiment provide a guide for clinical doctors and can give a clear predict for its efficacy.
引文
[1]Chiaffarino F, ParazziniF, La Vecchia C. Diet and uterine myomas. Obstet Gynecol,1999,94(3):396.
[2]Faersein E, Szldo M, Rosenshein NB. Risk factors for uterine leiomyoma:apractice-based ease-control study. Am J Epidemiol, 2001.153 (1):11-19.
[3]. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM (2003) High incidence of uterine leiomyoma in black and white women:Ultrasound evidence. Am J Obstet Gynecol 88:100-107.
[4]. Marshall LM, et al. (1997) Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol 90:967-973.
[5]. Kjerulff KH, Langenberg P, Seidman JD, Stolley PD, GuzinskiGM(1996) Uterine leiomyomas. Racial differences in severity, symptoms and age at diagnosis. J Reprod Med 41:483-490.
[6]. Myers ER, et al. (2001) Management of uterine fibroids (Evidence Report/Technology
[7]乐杰 妇产科学[M].第7版.北京：人民卫生出版社2008,269
[8]杜鹏辉 严绛绛 子宫肌瘤的病因学研究进展 中国 医师进修杂志2007,8(8)：2707-2709
[9]ShyamalD. Peddadaa, ShannonK. Laughlinb, KellyMinera, Jean-PhilippeGuyo nc, KarenHanekec,, HeatherL. Vahdatc, RichardC. Semelkad, AniaKowalike, Dian eArmaod, BarbaraDavisf, andDonnaDayBairdb, Growthofuterineleiomyomataamo ng premenopausalblack and whitewomen PANTS 112.16.2008,05(50):19887 19892
[10]周梅,文惠芳,子宫肌瘤与孕激素及细胞凋亡的相关研究[J]. 中国妇产科临床杂志,2003,4(1)：57-60
[11]Rein MS. Advances in uterine leiomyma research:the progeste rone hypot hesis. Environ Health Perspect,2000,108:791-793
[12]Kawaguchi K, Fujii S, Knoishi I. Mitotic activity in uterine leiomy2oms during the menst rual cyele[J]. AmJ obstet Gynecol,1989,160:637
[13]梁慧芬.中国药品手册.美迪医讯亚太有限公司,2002/2003：544
[14]陈伟平 还原性谷胱甘肽与2型糖尿病患者血糖和糖基化血红蛋白的关系中国糖尿病杂志2002,10,(4)：9363-9367.
[15]Ohtsubo M, Roberts Jm. Cychn-dependent regulation of G1 in mammalian frbroblm[J], Sc/encz,1999,259(5103):1910 - 1912.
[16]Murphy AA, Kettel LM. Regression of uterin leiomyo ma in response to the antiprgesterone RU486[J]. Clin Endocrinol Metab,1993,76 (2):513
[17]Harrison-Woolrych ML。 Charnakdones D S, Smith S K. Qu antification of messenger ribonucleic acid for epider mal growth in human myometriumand leiomyoma using reversetrans eriptas polymerase chain action [J]. ClinE ndocrinal Metab, 1994,78 (4):179.
[18]曹泽毅. 中华妇产科学(下册)[M].北京：人民卫生出版社,1999,1804-1817.
[19]何佳, 杨学荣. 腹腔镜手术与开腹手术治子宫肌瘤的比较分析. 局解手术学杂志,2004,13(6)：3882-3891
[20]曹树军 射频消融治疗子宫肌瘤的安全性研究郧阳医学院学报 (JYMC)2002年6月,21[20]黄俊花 刘昕 子宫肌瘤治疗进展中国社区医师医学专业半月刊 2008,10,(1)：71)：93
[21]姚书忠 子宫切除术治疗子宫肌瘤术式选择的考虑现代妇产科进展2007.5,16(5)：23医刊[J] 2003,30(19)：34
[22]傅芬 王春萌 子宫肌瘤进展 实用癌症2004.11,19,(6)：669-771
[23]王智彪,伍烽,王芷龙,等.聚焦多束超声对猴胎定位损伤及再孕的研 究(J).中国超声医学杂志,1999,15(4)：241.
[24]罗新,宋文霞,吴秀芝,等.射频消融技术对子宫肌瘤组织中ER,PR表达影响的临床试验研究[J].现代妇产科进展,2003,12(3)：204-206.
[25]梁志清, 陈勇,徐慧成,等. 腹腔镜广泛子宫切除术和盆腹腔淋巴结切除术23例分析[J]. 第三军医大学学报,2001,23(12)：1463-1465.
[26]孙芳, 姚凤媚, 徐建中.射频消融术治疗子宫肌瘤98例临床观察[J]. 江西医学院学报,2005,45(3)：139-141.
[27]曹树军, 曹淑彬. 射频消融治疗子宫肌瘤安全性研究[J]. 郧阳医学院学报,2002,21(3)： 132-135.
[28]亚茜. 射频消融治疗子宫肌瘤安全、有效[N].中国医学论坛报.2002-06-15(6).
[29]张红芳,藏晓英,陈迪文.射频自凝刀治疗子宫肌瘤30例分析[J].武汉大学学报,2002,23(1)：94296.
[30]刘景爱.BBT自凝刀治疗子宫肌瘤108例临床分析[J].中国妇幼保健,2002,17(2)：126.
[31]湛群,徐小琴.浅议自凝刀射频治疗子宫肌瘤的微创手术[J].井冈山医专学报,2001,8(6)：62263.
[32]Jiao LR, Hansen PD, Halpern DF, Havlik K, Mitry RR, Pignatelli M, Habib. Clinical short2term results of radio2frequency ablation in primaru and secondary liver tumors [J]. A m J S urg,1999; 177 (3):303-306.
[33]Bruce B. Lee. Radio2frequency ablation of uterine leiomyoma: A mew minimally invasive hysterectomy alternative [J]. Obstet Gynecol, 2002;99 (4):S9.
[34]Mirza AN, Formage BD, Sneige N, Kuever HM, Newman LA, Ames FC, Singletavy SE. Radio2frequency ablation of solid tumors [J]. Cancer J,2001;7 (2):95-102.
[35]张庭 超声在射频消融治疗子宫肌瘤中的应用 中国超声医学杂志, 2004,20(7):531-534
[36]Jiao LR, Hansen PD, Halpern DF, Havlik K, Mitry RR, Pignatelli M, Habib. Clinical short2term results of radio2frequency ablation in primaru and secondary liver tumors [J]. A m J S urg,1999; 177 (3):303-306.
[37]Bruce B. Lee. Radio2frequency ablation of uterine leiomyoma: A mew minimally invasive hysterectomy alternative [J]. Obstet Gynecol, 2002;99 (4):S9.
[2]Faersein E, Szldo M, Rosenshein NB. Risk factors for uterine leiomyoma:apractice-based ease-control study. Am J Epidemiol, 2001.153 (1):11-19.
[3]. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM (2003) High incidence of uterine leiomyoma in black and white women:Ultrasound evidence. Am J Obstet Gynecol 88:100-107.
[4]. Marshall LM, et al. (1997) Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol 90:967-973.
[5]. Kjerulff KH, Langenberg P, Seidman JD, Stolley PD, GuzinskiGM(1996) Uterine leiomyomas. Racial differences in severity, symptoms and age at diagnosis. J Reprod Med 41:483-490.
[6]. Myers ER, et al. (2001) Management of uterine fibroids (Evidence Report/Technology
[7]乐杰 妇产科学[M].第7版.北京：人民卫生出版社2008,269
[8]杜鹏辉 严绛绛 子宫肌瘤的病因学研究进展 中国 医师进修杂志2007,8(8)：2707-2709
[9]ShyamalD. Peddadaa, ShannonK. Laughlinb, KellyMinera, Jean-PhilippeGuyo nc, KarenHanekec,, HeatherL. Vahdatc, RichardC. Semelkad, AniaKowalike, Dian eArmaod, BarbaraDavisf, andDonnaDayBairdb, Growthofuterineleiomyomataamo ng premenopausalblack and whitewomen PANTS 112.16.2008,05(50):19887 19892
[10]周梅,文惠芳,子宫肌瘤与孕激素及细胞凋亡的相关研究[J]. 中国妇产科临床杂志,2003,4(1)：57-60
[11]Rein MS. Advances in uterine leiomyma research:the progeste rone hypot hesis. Environ Health Perspect,2000,108:791-793
[12]Kawaguchi K, Fujii S, Knoishi I. Mitotic activity in uterine leiomy2oms during the menst rual cyele[J]. AmJ obstet Gynecol,1989,160:637
[13]梁慧芬.中国药品手册.美迪医讯亚太有限公司,2002/2003：544
[14]陈伟平 还原性谷胱甘肽与2型糖尿病患者血糖和糖基化血红蛋白的关系中国糖尿病杂志2002,10,(4)：9363-9367.
[15]Ohtsubo M, Roberts Jm. Cychn-dependent regulation of G1 in mammalian frbroblm[J], Sc/encz,1999,259(5103):1910 - 1912.
[16]Murphy AA, Kettel LM. Regression of uterin leiomyo ma in response to the antiprgesterone RU486[J]. Clin Endocrinol Metab,1993,76 (2):513
[17]Harrison-Woolrych ML。 Charnakdones D S, Smith S K. Qu antification of messenger ribonucleic acid for epider mal growth in human myometriumand leiomyoma using reversetrans eriptas polymerase chain action [J]. ClinE ndocrinal Metab, 1994,78 (4):179.
[18]曹泽毅. 中华妇产科学(下册)[M].北京：人民卫生出版社,1999,1804-1817.
[19]何佳, 杨学荣. 腹腔镜手术与开腹手术治子宫肌瘤的比较分析. 局解手术学杂志,2004,13(6)：3882-3891
[20]曹树军 射频消融治疗子宫肌瘤的安全性研究郧阳医学院学报 (JYMC)2002年6月,21[20]黄俊花 刘昕 子宫肌瘤治疗进展中国社区医师医学专业半月刊 2008,10,(1)：71)：93
[21]姚书忠 子宫切除术治疗子宫肌瘤术式选择的考虑现代妇产科进展2007.5,16(5)：23医刊[J] 2003,30(19)：34
[22]傅芬 王春萌 子宫肌瘤进展 实用癌症2004.11,19,(6)：669-771
[23]王智彪,伍烽,王芷龙,等.聚焦多束超声对猴胎定位损伤及再孕的研 究(J).中国超声医学杂志,1999,15(4)：241.
[24]罗新,宋文霞,吴秀芝,等.射频消融技术对子宫肌瘤组织中ER,PR表达影响的临床试验研究[J].现代妇产科进展,2003,12(3)：204-206.
[25]梁志清, 陈勇,徐慧成,等. 腹腔镜广泛子宫切除术和盆腹腔淋巴结切除术23例分析[J]. 第三军医大学学报,2001,23(12)：1463-1465.
[26]孙芳, 姚凤媚, 徐建中.射频消融术治疗子宫肌瘤98例临床观察[J]. 江西医学院学报,2005,45(3)：139-141.
[27]曹树军, 曹淑彬. 射频消融治疗子宫肌瘤安全性研究[J]. 郧阳医学院学报,2002,21(3)： 132-135.
[28]亚茜. 射频消融治疗子宫肌瘤安全、有效[N].中国医学论坛报.2002-06-15(6).
[29]张红芳,藏晓英,陈迪文.射频自凝刀治疗子宫肌瘤30例分析[J].武汉大学学报,2002,23(1)：94296.
[30]刘景爱.BBT自凝刀治疗子宫肌瘤108例临床分析[J].中国妇幼保健,2002,17(2)：126.
[31]湛群,徐小琴.浅议自凝刀射频治疗子宫肌瘤的微创手术[J].井冈山医专学报,2001,8(6)：62263.
[32]Jiao LR, Hansen PD, Halpern DF, Havlik K, Mitry RR, Pignatelli M, Habib. Clinical short2term results of radio2frequency ablation in primaru and secondary liver tumors [J]. A m J S urg,1999; 177 (3):303-306.
[33]Bruce B. Lee. Radio2frequency ablation of uterine leiomyoma: A mew minimally invasive hysterectomy alternative [J]. Obstet Gynecol, 2002;99 (4):S9.
[34]Mirza AN, Formage BD, Sneige N, Kuever HM, Newman LA, Ames FC, Singletavy SE. Radio2frequency ablation of solid tumors [J]. Cancer J,2001;7 (2):95-102.
[35]张庭 超声在射频消融治疗子宫肌瘤中的应用 中国超声医学杂志, 2004,20(7):531-534
[36]Jiao LR, Hansen PD, Halpern DF, Havlik K, Mitry RR, Pignatelli M, Habib. Clinical short2term results of radio2frequency ablation in primaru and secondary liver tumors [J]. A m J S urg,1999; 177 (3):303-306.
[37]Bruce B. Lee. Radio2frequency ablation of uterine leiomyoma: A mew minimally invasive hysterectomy alternative [J]. Obstet Gynecol, 2002;99 (4):S9.