高强度聚焦超声治疗T2WI高信号子宫肌瘤的效果及安全性分析
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摘要
目的探讨高强度聚焦超声治疗T2WI高信号子宫肌瘤的效果及安全性。方法选取2014年5月～2017年7月我院收治的160例T2WI高信号子宫肌瘤患者作为研究对象,所有患者均行高强度聚焦超声治疗。比较患者不同部位子宫肌瘤的体积消融率及能效因子(EEF)水平;比较患者不同大小子宫肌瘤的体积消融率及EEF水平;所有患者随访1年,高强度聚焦超声对患者阴道分泌物及卵巢功能的影响;记录并评价患者经高强度聚焦超声治疗后的不良反应发生情况。结果子宫肌瘤位于后壁的体积消融率低于前壁,EEF水平高于前壁和侧壁,差异均有统计学意义(P<0.05);不同大小子宫肌瘤的体积消融率比较,差异无统计学意义(P>0.05);子宫肌瘤平均径线>7 cm的EEF水平低于子宫肌瘤平均径线<4 cm及4～7 cm,差异均有统计学意义(P<0.05);患者行高强度聚焦超声治疗3个月后,复查雌激素、孕激素、卵泡刺激素等水平均未发现异常;未发生严重不良反应;肌瘤与宫腔距离<5 mm者阴道分泌物异常发生率低于肌瘤与宫腔距离≥5 mm,差异有统计学意义(P<0.05)。结论高强度聚焦超声治疗T2WI高信号子宫肌瘤效果显著、安全可靠,值得临床推广应用。
Objective To explore the effect and safety of high intensity focused ultrasound in the treatment of T2WI high signal uterine leiomyoma. Methods A total of 160 patients with hyperintense uterine fibroids on T2WI admitted to our hospital from May 2014 to July 2017 were selected as the study subjects, all patients were treated with high intensity focused ultrasound. The volume ablation rate and energy efficiency factor(EEF) level of uterine leiomyoma in different parts of patients were compared. The volume ablation rate and EEF level of uterine leiomyoma in different sizes of patients were compared. All patients were followed up for one year, and the effects of high intensity focused ultrasound on vaginal secretion and ovarian function were recorded and evaluated. Adverse reactions after high intensity focused ultrasound treatment were recorded and evaluated. Results The volume ablation rate of uterine leiomyoma in the posterior wall was lower than that in the anterior wall, and the EEF level was higher than that in the anterior wall and the lateral wall, the differences were significant(P<0.05). There was no significant difference in volume ablation rate between different size uterine leiomyomas(P>0.05). The EEF level of uterine leiomyoma with mean diameter > 7 cm was lower than that of uterine leiomyoma with mean diameter < 4 cm and 4-7 cm, the differences were statistically significant(P<0.05). After 3 months of HIFU treatment, no abnormalities were found in estrogen, progesterone and follicle stimulating hormone levels. No serious adverse reactions occurred. The incidence of vaginal secretion abnormality in patients with uterine cavity distance less than 5 mm was lower than that in patients with uterine cavity distance more than 5 mm, the difference was significant(P<0.05). Conclusions High intensity focused ultrasound is effective, safe and reliable in the treatment of hyperintense uterine fibroids on T2WI, which is worthy of clinical application.
Objective To explore the effect and safety of high intensity focused ultrasound in the treatment of T2WI high signal uterine leiomyoma. Methods A total of 160 patients with hyperintense uterine fibroids on T2WI admitted to our hospital from May 2014 to July 2017 were selected as the study subjects, all patients were treated with high intensity focused ultrasound. The volume ablation rate and energy efficiency factor(EEF) level of uterine leiomyoma in different parts of patients were compared. The volume ablation rate and EEF level of uterine leiomyoma in different sizes of patients were compared. All patients were followed up for one year, and the effects of high intensity focused ultrasound on vaginal secretion and ovarian function were recorded and evaluated. Adverse reactions after high intensity focused ultrasound treatment were recorded and evaluated. Results The volume ablation rate of uterine leiomyoma in the posterior wall was lower than that in the anterior wall, and the EEF level was higher than that in the anterior wall and the lateral wall, the differences were significant(P<0.05). There was no significant difference in volume ablation rate between different size uterine leiomyomas(P>0.05). The EEF level of uterine leiomyoma with mean diameter > 7 cm was lower than that of uterine leiomyoma with mean diameter < 4 cm and 4-7 cm, the differences were statistically significant(P<0.05). After 3 months of HIFU treatment, no abnormalities were found in estrogen, progesterone and follicle stimulating hormone levels. No serious adverse reactions occurred. The incidence of vaginal secretion abnormality in patients with uterine cavity distance less than 5 mm was lower than that in patients with uterine cavity distance more than 5 mm, the difference was significant(P<0.05). Conclusions High intensity focused ultrasound is effective, safe and reliable in the treatment of hyperintense uterine fibroids on T2WI, which is worthy of clinical application.
引文
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[11]王伟,张暹东,李祎,等.动态增强磁共振成像定量参数对子宫肌瘤高强度聚焦超声治疗效果的即时评估价值初探[J].磁共振成像,2015,6(8):603-607.
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[13]Brolmann H,Tanos V,Grimbizis G,et al.Options on fibroid morcellation:a literature review[J].Gynecol Surg,2015,12(1):1-13.
[14]于春霞,陶玲,周琦.宫腔镜电切术与子宫动脉栓塞术治疗黏膜下子宫肌瘤的疗效分析[J].中国妇幼保健,2015,30(23):4041-4043.
[15]冉剑波,黄浩然,李非,等.高强度聚焦超声消融不同T2WI信号子宫肌瘤疗效差异的组织病理学研究[J].中国介入影像与治疗学,2016,13(5):318-321.
[16]陈燕,蒋静,周洪贵.子宫肌瘤超声消融治疗中病灶声像图灰度变化的意义[J].临床超声医学杂志,2015,17(9):602-604.
[2]刘佳,张晓东,容蓉,等.MR引导下高强度聚焦超声消融子宫肌瘤温度曲线参数与治疗效果的关系[J].中国介入影像与治疗学,2018,15(5):268-272.
[3]Kr o ncke T,David M.Uterine artery embolization(UAE)for fibroid treatment-results of the 5th radiological gynecological expert meeting[J].Geburtshilfe Frauenheilkd,2015,75(5):439-441.
[4]罗爽,王艳,何佳.高强度聚焦超声消融联合孕三烯酮治疗子宫腺肌病的疗效评价[J].重庆医学,2018,47(2):170-172.
[5]姜曼,赵卫,易根发,等.子宫肌瘤MRI特征与高强度聚焦超声消融疗效[J].介入放射学杂志,2014,23(4):314-319.
[6]曹卉娟,邢建民,刘建平.视觉模拟评分法在症状类结局评价测量中的应用[J].中医杂志,2009,50(7):600-602.
[7]侯静,刘晟,王维,等.MRIT2WI信号强度与高强度聚焦超声消融子宫肌瘤疗效关系的研究[J].医学影像学杂志,2014,24(5):820-823.
[8]彭静,柳杨.高强度聚焦超声消融治疗60例有症状子宫肌瘤的临床观察[J].中国计划生育和妇产科,2016,8(8):55-57,66.
[9]胡美丽,王雅慧,杨欣,等.高强度聚焦超声消融治疗子宫肌瘤疗效观察[J].武警医学,2015,26(11):1115-1117.
[10]申恒春,周丹,倪亚非,等.子宫肌瘤超声消融剂量-效应关系研究[J].四川医学,2013,34(11):1619-1621.
[11]王伟,张暹东,李祎,等.动态增强磁共振成像定量参数对子宫肌瘤高强度聚焦超声治疗效果的即时评估价值初探[J].磁共振成像,2015,6(8):603-607.
[12]周虎,赵卫东.高强度聚焦超声治疗子宫肌瘤的临床研究进展[J].现代妇产科进展,2016,25(1):59-61.
[13]Brolmann H,Tanos V,Grimbizis G,et al.Options on fibroid morcellation:a literature review[J].Gynecol Surg,2015,12(1):1-13.
[14]于春霞,陶玲,周琦.宫腔镜电切术与子宫动脉栓塞术治疗黏膜下子宫肌瘤的疗效分析[J].中国妇幼保健,2015,30(23):4041-4043.
[15]冉剑波,黄浩然,李非,等.高强度聚焦超声消融不同T2WI信号子宫肌瘤疗效差异的组织病理学研究[J].中国介入影像与治疗学,2016,13(5):318-321.
[16]陈燕,蒋静,周洪贵.子宫肌瘤超声消融治疗中病灶声像图灰度变化的意义[J].临床超声医学杂志,2015,17(9):602-604.
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