改良射频消融术治疗较大子宫肌瘤的疗效观察

Clinical Effects of Improved Radiofrequency Ablation on Major Uterine Myomas

目的对比常规射频消融术、改良射频消融术及改良射频消融术后取瘤治疗较大子宫肌瘤的临床效果。方法选择2005年12月—2008年12月中国人民解放军463医院经临床和超声检查确诊为子宫肌瘤的患者155例,瘤体直径>5cm。分为常规组38例,改良组62例,取瘤组55例,分别采用射频消融技术及在此基础上增加治疗时间和治疗后一个月取瘤的方法进行治疗。采用三维彩超测量术前及术后1、3、6个月子宫及肌瘤体积。比较3组患者术后子宫及肌瘤体积缩小情况。结果术后3组各有部分患者阴道有少量血水、肉末样物或肉块样物排出;瘤体吸收期间出现低热,多自行缓解。射频治疗后3组患者的子宫及肌瘤体积进行性缩小。术后1个月时3组患者子宫和肌瘤体积缩小率间差异无统计学意义(P>0.05)。术后3个月及6个月时取瘤组子宫和肌瘤体积均较其他两组明显缩小(P<0.05)。术后6个月时常规组治愈2例,显效6例,有效20例,无效10例;改良组治愈6例,显效20例,有效31例,无效5例;取瘤组治愈25例,显效19例,有效11例,3组疗效间两两比较差异均有统计学意义(P<0.05)。结论较大子宫肌瘤采用改良射频消融术后取瘤治疗可明显减少子宫体积和肌瘤体积,术后不良反应少。

Objective To assess the clinical effects of improved radiofrequency ablation （RFA） on major uterine myomas （UM） （diameter 〉 5 cm）. Methods One hundred fifty- five UM patients, diagnosed through clinic and uhrasonography in PLA No. 463 Hospital from December 2005 to December 2008, were divided into groups conventional （ n = 38） , improved （n =62） and cnucleating （n =55） , and treated by usual RFA, improved RFA and enucleating UM after RFA, respectively. Three - dimensional color Doppler ultrasound was used to measure uterine size and UM volume before operation or months 1, 3, 6 after. The decreased sizes were compared between 3 groups. Results A small amount of blood, minced meat - like or lump meat -like objects was discharged in 3 groups; low grade fever appeared and then remitted spontaneously during tumor absorption. Progressive minification of uterine size and UM volume were progressively minified. There was not significant difference in minification of uterine size and UM volume between 3 groups 1 month after operation （ P 〉 0. 05 ）. The uterine size and UM volume were significantly smaller in enucleating group than in the other 2 groups 3 or 6 months after operation （ P 〈 0.05 ）. Six months after operation, 2 patients were cured, markedly efficacy was found in 6, efficacy in 20, no efficacy in 10 in eonventional group, and 6, 20, 31, 5, respectively, in improved group, and 26, 19, 11, 0, respectively, in enueleating group. The difference was significant between 3 groups （ P 〈 0. 05 ）. Conclusion Enucleating major UM from uterus after RFA can obviously reduce uterine size and UM volume with fewer adverse reactions.