HIFU消融子宫肌瘤后浆肌层损伤对消融治疗有效性及安全性的影响

Impact on treatment safety and efficacy of seromuscular-layer injury after HIFU ablation for uterine fibroids

目的探讨HIFU消融子宫肌瘤后浆肌层损伤对消融治疗有效性及安全性的影响。方法对400例接受HIFU消融治疗的子宫肌瘤患者,依据术后增强MRT1WI显示子宫肌层灌注全时段矢状位或轴位图像上子宫浆肌层是否出现灌注缺损分为损伤组和完整组。比较2组间患者年龄、体质量指数(BMI)、子宫肌瘤位置、类型(浆膜下、黏膜下及肌壁间肌瘤)、体积、肌瘤前缘至前腹壁的距离、消融参数(功率、总剂量)、消融后肌瘤无灌注区体积(NPV)、消融率、能效因子、术后并发症及患者术后妊娠率的差异。结果损伤组90例,完整组310例。2组间患者年龄、子宫肌瘤体积、肌瘤前缘至前腹壁的距离、HIFU消融功率、NPV差异均无统计学意义(P均>0.05),宫肌瘤位置及类型差异均有统计学意义(P均<0.05);损伤组较完整组患者BMI及消融率更高(P均<0.05)、HIFU消融总剂量及EEF更低(P均<0.05)。2组均未出现国际介入放射治疗学会(SIR)分级C^F级并发症,发热、骶尾部疼痛、下腹部疼痛等SIRA、B级并发症差异均无统计学意义(P均>0.05);术后妊娠率分别为5.56%(5/90)及2.26%(7/310),差异无统计学意义(χ2=1.596,P=0.206),无妊娠及分娩相关不良事件发生。结论HIFU消融子宫肌瘤后可能出现子宫浆肌层损伤,高BMI、位于宫底的浆膜下肌瘤、易消融肌瘤(消融剂量及EEF低、消融率高)HIFU消融术后浆肌层损伤风险高。浆肌层损伤对于术后妊娠及分娩并无显著影响。

Objective To investigate the impact on treatment efficacy and safety of seromuscular-layer injury after ablation with HIFU for uterine fibroids. Methods A total of 400 patients with uterine fibroids who underwent HIFU ablation were enrolled. All patients had completed MRI data before and after ablation. According to postoperative enhanced MR T1WI showing whether there was perfusion defect of seromuscular-layer on sagittal or axial images of whole myometrial perfusion period, the patients were divided into injured group and intact group. The patients' age, body mass index (BMI), location of uterine fibroids, type (subserous, submucous or intermural myoma), volume, distance from anterior margin of myoma to anterior abdominal wall, parameters of ablation (power and total energy), non-perfused volume (NPV) after ablation, ablation rate, energy efficiency factor (EEF), postoperative complications and pregnancy rate were compared between the two groups. Results There were 90 cases in injured group and 310 cases in intact group. No statistical difference of patients' age, volume of uterine fibroids, distance from anterior margin of myoma to anterior abdominal wall, power of ablation nor NPV was found between the two groups (all P >0.05).There were statistical differences of location and type of uterine fibroids (both P <0.05). BMI and ablation rate of injured group were higher than those of intact group (both P <0.05), while the total energy of ablation and EEF were lower than those of intact group (both P <0.05). No complications graded as C-F of society of interventional radiology (SIR) occurred. There was no statistical difference of the incidence of SIR A and B grade complications, such as fever, sacrocaudal pain and lower abdominal pain between the two groups (all P >0.05). The postoperative pregnancy rate of the injured group and the intact group was 5.56%(5/90) and 2.26%(7/310), respectively. And there was no statistical difference (χ 2 =1.596, P =0.206). No adverse event related to pregnancy and deliver was observed. Conclusion HIFU ablation for uterine fibroids may lead to uterine seromuscular-layer injury, which can be observed in patients with high BMI, subserosal fibroids at the fundus of uterus and easy to ablate fibroids (low ablation energy and EEF, high ablation rate). The postoperative pregnancy and delivery are not obviously affected by seromuscular-layer injury.