高强度聚焦超声和射频消融治疗不同等级血供子宫肌瘤的疗效比较

A comparative study of complete ablation rate of fibroid with different grade of blood supply using radio frequency and high-intensity focused ultrasound

目的通过超声造影技术评价高强度聚焦超声(HIFU)和射频(RF)消融治疗不同等级血供子宫肌瘤的疗效并进行比较。方法 2009年1—12月第四军医大学西京医院110例子宫肌瘤患者共146个肌瘤随机分为HIFU组及RF组,每组各55例,分别接受HIFU及RF治疗。术前对肌瘤行彩色多普勒血流成像检查,将肌瘤内血供半定量分为G1、G2、G3三级。HIFU组患者肌瘤血供G1级15例患者共20个肌瘤,G2级32例患者共38个肌瘤,G3级8例患者共10个肌瘤。RF组患者G1级14例患者共18个肌瘤,G2级31例患者共42个肌瘤,G3级10例患者共18个肌瘤。所有患者均于治疗前、后1周内行超声造影。肌瘤内部无造影剂灌注,周边光滑完整为消融完全;肌瘤内部及(或)边缘出现不规则片状增强区者为消融不全。采用Chi-square χ2检验比较HIFU组与RF组不同等级血供子宫肌瘤完全消融率、HIFU组与RF组患者术后并发症发生率。结果血供为G1级的子宫肌瘤,HIFU组与RF组完全消融率差异无统计学意义[80.0%(16/20) vs 88.9%(16/18),χ2=0.563,P>0.05];血供为G2级、G3级的子宫肌瘤,RF组完全消融率均高于HIFU组[90.5%(38/42) vs 55.3%(21/38),72.2%(13/18) vs 20.0%(2/10)],且差异均有统计学意义(χ2值分别为12.778、7.049,P均<0.05)。术后并发症包括发热、下腹部疼痛、盆腔积液、阴道排液及单侧下肢麻木。HIFU组术后并发症发生率低于RF组[9.1%(5/55) vs 27.3%(15/55)],且差异有统计学意义(χ2=6.111,P<0.05)。结论 HIFU和RF对于血供稀少的肌瘤均有较好的消融效果;而对于血供较丰富的子宫肌瘤,RF的治疗效果优于HIFU。因此,RF适用于大部分的子宫肌瘤。而HIFU作为一种无创治疗手段,并发症少,可做为少血供子宫肌瘤非手术治疗的首选方法。

Objective To compare the complete ablation rate of radiofrequency (RF) ablation and high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids with different blood supply.Methods One hundred and ten patients with 146 uterine fibroids in Xijing Hospital of the Fourth Military Medical University from January 2009 to December were randomly divided into two groups and treated with HIFU or RF respectively.Each group had 55 patients.All patients were examined by color Doppler flow imaging before the treatment.The blood supply of fibroids were semi-quantitatively classified into three grades including G1,G2 and G3.The HIFU group had 15 patients with 20 fibroids in which blood supply was G1,had 32 patients with 38 fibroids in which blood supply was G2,and had 8 patients with 10 fibroids in which blood supply was G3.The RF group had 14 patients with 18 fibroids in which blood supply was G1,had 31 patients with 42 fibroids in which blood supply was G2,and had 10 patients with 18 fibroids in which blood supply was G3.The complete ablation rates of the two treatments were evaluated by contrast-enhanced ultrasound one week before and after treatments.Fibroids which had no contrast agent perfusion and smooth boundary were completely ablated.Statistical analyses were used to compare the complete ablation rates and postoperative complications rates of these two methods.Results When fibroidís blood supply was G1,the complete ablation rate was 80.0%(16/20) and 88.9%(16/18) in HIFU and RF group,respectively.The difference was not statistically significant (χ2=0.563,P>0.05).When fibroidís blood supply was G2 and G3,the complete ablation rate in HIFU and RF group was 90.5%(38/42) vs 55.3%(21/38) and 72.2% (13/18) vs 20.0% (2/10),respectively.There was statistically difference between these two groups (χ2=12.778,P<0.05;χ2=7.049,P<0.05,respectively).Postoperative complications included fever,abdominal pain,pelvic effusion and vaginal discharge and unilateral lower limb numbness.The incidence of complications was lower in HIFU group than that in RF group,which was 9.1%(5/55) and 27.3%(15/55) respectively,This difference was statistically significant (χ2=6.111,P<0.05).Conclusions HIFU and RF are both effective in treating uterine fibroids with few blood supply.However,RF can be more effective than HIFU in treating hypervascular fibroids.Therefore,RF might be able to apply to majority of the fibroids.As a non-invasive therapy,HIFU is more suitable for hypovascular fibroids and could be the first therapy in clinic.