子宫肌瘤不同声像图表现在高强度聚焦超声治疗中的疗效差异分析

The Effect of High Intensity Focused Ultrasound Treatment for Uterine Fibroids

目的:通过对超声图像分析,探讨影响高强度聚焦超声治疗子宫肌瘤疗效的因素。方法:28例(共32个肌瘤)确诊为子宫肌瘤的患者,进行高强度聚焦超声治疗。肌瘤按体积分为<4cm3、4～65cm3、>65cm3三类,按类型分为浆膜下、肌壁间、粘膜下三类,按回声强度分为高回声型、等回声型、低回声型三类,按回声均匀度分为回声不均匀、回声欠均匀、回声尚均匀三类。在术后6个月通过超声检查及临床症状改善情况进行疗效评估,分为治愈、显效、有效和无效四个等级。分析肌瘤不同体积、类型、回声强度及回声均匀程度与疗效的关系。结果:不同体积、类型、回声强度及回声均匀度的子宫肌瘤在高强度聚焦超声治疗中的疗效各有不同,各组间比较,差异具有统计学意义(P<0.05)。不同体积的肌瘤:4～65cm3的肌瘤疗效最好,<4cm3的肌瘤疗效最差,>65cm3的肌瘤疗效介于两者之间;不同类型的肌瘤:肌壁间肌瘤疗效最好,浆膜下肌瘤疗效最差,粘膜下肌瘤疗效介于两者之间;不同回声强度的肌瘤:高回声型疗效最好,低回声型疗效最差,等回声型疗效介于两者之间;不同回声均匀度的肌瘤:回声不均匀者疗效最好,回声尚均匀者疗效最差,回声欠均匀者疗效介于两者之间。结论:通过对子宫肌瘤声像图与疗效关系分析,可以提高超声评价高强度聚焦超声治疗子宫肌瘤疗效的准确性,进一步指导临床选择适当的治疗剂量和预测疗效。

Objective： To investigate the influencing factors of therapeutic efficacy of high intensity focused ultrasound （HIFU） treatment for uterine fibroids through analyzing the sonogram. Methods： A total of 28 patients with uterine fibroids （32 uterine flbroids in total） were treated with HIFU. We evaluated the correlations of different volume, type, echo intensity, echo homogeneity with the therapeutic efficacy. The uterine fibroids were divided into 3 groups according to each factor： 3 groups by size： 〈4cm^3, 4-65cm^3 and 〉65cm^3; 3 groups by types： subserous myoma, intramural myoma and submucous myoma; 3 groups by echo intensity： hyper echo, iso-echo and hypo echo; 3 groups by echo homogeneity： heterogeneity, lack of uniformity and uniformity. At 6 months after HIFU treatment, the results were assessed by ultrasound examination and clinical symptom changes. The treatment outcomes were of four classes： curative, excellent, effective and ineffective. Results： With different volume, type, echo intensity and echo homogeneity, the therapeutic efficacy of HIFU treatment was different （P〈0.05）. For uterine fibroids of different size, therapeutic efficacy was best in the 4-65cm^3 group, worst in the 〈4cm^3 group and intermediate in the 〉65cm^3 group. For different types of uterine fibroids, the therapeutic efficacy was best in the intramural myoma group, poorest in the subserous myoma group, and intermediate in the submucous myoma group. For the different echo intensity of uterine fibroids： the hyper-echo group had the best therapeutic efficacy, the hypo-echo group had the poorest therapeutic efficacy, and the iso-echo group had the intermediate therapeutic efficacy. For the different echo homogeneity of uterine fibroids, the efficacy of HIFU was best in the heterogeneity group, poorest in the uniformity group, and intermediate in the group in lack of echo uniformity. Conclusion： Analysis of the correlation between the sound image of uterine fibroids and the efficacy of HIFU is helpful for evaluating the accuracy of ultrasound in measuring the effect of HIFU.