高强度聚焦超声消融多发性子宫肌瘤的影响因素

Factors affecting the efficacy of high-intensity focused ultrasound ablation for multiple uterine fibroids

目的探讨高强度聚焦超声(HIFU)消融多发性子宫肌瘤的影响因素。方法对HIFU治疗的139例多发性、症状性子宫肌瘤患者进行回顾性分析。将所有的子宫肌瘤分组,多分类变量分别设定哑变量后,将各个哑变量、患者年龄、均匀与否、肌瘤体积、T1增强信号、靶皮距、后声场距离设为自变量,将设能效因子(EEF)为因变量,用stepwise的方法进行多重线性回归分析。结果患者平均年龄为(39.2±5.7)岁,平均肌瘤体积为(81.7±60.5) cm^3,平均消融率为(73.9±14.2)%,平均EEF为(6.9±4.2) j/mm^3。共6个自变量被选入多重线性回归模型,选择模型6进行分析(调整R^2=0.326,F=11.383,P<0.001)。根据多重线性回归方程及其偏回归系数可知,EEF与位置、T1增强、肌瘤径线、肌瘤类型、后声场距离有线性相关关系,且T1增强对EEF影响最大。结论 HIFU对多发性子宫肌瘤的消融效果受肌瘤位置、血供、大小等因素的影响,其中血供(T1增强)对其影响较大。

Objective To investigate the factors influencing the efficacy of highintensity focused ultrasound （HIFU） ablation for multiple uterine fibroids. Methods The clinical data of a total of 139 patients with multiple and symptomatic uterine fibroids, who had received HIFU treatment at authors＂ hospital, were retrospectively analyzed. All fibroids were classified into groups, and the multiple classification variables were separately set as dummy variables. Each dummy variable, age of patients, homogeneous or inhomogeneous, volume of fibroid, TI enhancement signal, target-skin distance, and post-sound field distance were set as independent variables; the energy efficiency factor （EEF） was set as dependent variable. Using stepwise method, the multiple linear regression analysis was conducted. Results The average age of the patients was （39.2±5.7） years old, the mean volume of fibroids was （81.7±60.5） cm3, the average ablation rate was （73.9± 14.2）%, and the mean EEF was （6.9±4.2） j/mm3. A total of 6 independent variables were selected into multiple linear regression models, and the Model-6 was selected for statistical analysis （adjusted R2=0.326, F=11.383, P〈0.001）. Multiple linear regression equations and their partial regression coefficients revealed that a linear correlation existed between EEF and the following parameters, including lesion＇s position, T1 enhancement, diameter of fibroid, type of fibroid and post-sound field distance, among them T! enhancement had the greatest impact on EEF. Conclusion The ablation effect of HIFU on multiple uterine fibroids is influenced by the lesion＇s location, blood supply, size, etc., and the blood supply （T1 enhancement） has the greatest impact on the ablation effect.