高强度聚焦超声治疗子宫肌瘤的疗效观察

The treatment effects of high intensity focused ultrasound on uterine leiomyoma

目的探讨高强度聚焦超声(HIFU)治疗子宫肌瘤的有效性。方法选择33例妇科确诊为子宫肌瘤的患者进行HIFU治疗。HIFU治疗3个月后对非手术患者行彩色多普勒超声随诊,观察子宫肌瘤内部回声、血供及瘤体体积改变;对手术患者行MRI增强扫描,观察HIFU治疗24h后肌瘤内有无出现坏死及其病理改变。结果33例中8例HIFU治疗24h后行增强MRI扫描及手术切除术,子宫肌瘤标本中均显示靶区坏死,坏死范围与治疗范围相近。光镜下显示HIFU治疗后肌瘤内细胞变性坏死、核浓染、固缩,并见肌瘤内微血管破坏。25例非手术患者治疗后3～16个月随诊观察,23例临床症状减轻或消失,超声显示4例治疗显效,子宫肌瘤消失;19例治疗有效。患者子宫肌瘤体积缩小(约20.1%～94.3%);2例(2/25)治疗无效。13例(13/33)HIFU治疗后出现一过性神经刺激等症状,2例出现皮肤I度烫伤,未经任何治疗次日自行消退,未出现其他不良反应。结论HIFU治疗子宫肌瘤有效,安全性好,但远期疗效尚需长期随访观察。

Objective To evaluate the therapeutic effects of HIFU on uterine leiomyoma. Methods Thirty-threepatients with uterine leiomyoma were treated with HIFU in the study. The inner echoes, blood supplies and volumes of myomas in 25 non-operatlve patients were observed by the color Doppler flow imaging （CDFI） three months after treatment. Eight patients who received operation after HIFU treatment were observed 24 hours later via contrast-enhanced MRI. Histopathologic changes were compared before and after the HIFU treatment. Results The obvious necrosis in the area of uterine leiomyoma was treated with HIFU treatment and was observed in 8 operative patients after 24 hour therapy. The size of necrosis was in accordance with the size of the treatment areas. The cell degeneration and necrosis, nuclear hyperchromatism and pycnosis as well as microangiums injuries were observed in the uterine leiomyoma by the microscope. Twenty-five non-operative patients were followed up for 3-16 months after HIFU. The clinical symptoms were alleviated or recovered in 23 patients, among them ; 4 patients had no evidence of residual tumor, and the tumor volume was decreased by 20.1%-94.3% in 19 patients; two patients had no change in the size of the tumor. Thirteen patients （ 13/33 ） had adverse effects （ e. g. transient radiated pain ） due to sacro-coccygeal nerve stimulation, rectal prolapse and bladder irritation. Moreover, 2 patients experienced first-degree skin burn, which was self-limited without any treatment on the next day. Conclusions HIFU treatment is effective and safe on uterine leiomyomas, but long-term therapeutic effects were further needed.