人体子宫肌瘤在高强度聚焦超声治疗后彩色多普勒超声及离体子宫病理观察

Color Doppler ultrasound and pathological observation of human uterine leiomyomas treated with high intensity focused ultrasound

目的观察人在体子宫肌瘤经高强度聚焦超声(HIFU)辐照后彩色多普勒超声表现及离体子宫病理改变。方法于子宫全切除术前5d采用HIFU对11例患者23个子宫平滑肌瘤行三维适形扫描治疗,治疗后对患者照射靶区子宫肌瘤行彩色多普勒超声检测。并在子宫切除术后对HIFU治疗靶区组织行病理及电镜检查。结果 HIFU辐照5d后,彩色多普勒超声显示11例中23个子宫平滑肌瘤内部回声较辐射前明显增强,周边及内部血流信号减少或消失。切除子宫标本病理检查显示11例23个子宫肌瘤HIFU照射靶区组织质硬、灰白、部分区域呈暗紫与灰白色相间;光镜下显示治疗区组织中细胞变性坏死、核固缩、浓染,血管内皮细胞变性较著。电镜显示细胞膜断裂结构不完整,核膜消失,核碎裂溶解,血管内皮细胞核消失、核膜不完整并见空泡形成。结论 HIFU为非侵入性治疗子宫肌瘤的新技术,HIFU辐照后子宫平滑肌瘤内部声像、血运等彩色多普勒超声表现及局部组织病理形态均有显著改变,以子宫肌瘤内部回声明显增强,周边及内部血流信号减少、消失及局部组织细胞变性坏死为著。

Objective To assess the color Doppler ultrasound and pathological changes of human uterine leiomyomas treated with hign intensity focused ultrasound （HIFU）. Methods Three-dimensional conformal scan therapy with HIFU was used for 11 patients selected with uterine leiomyomas who needed total hysterectomy after acquiring their permission before the operation. On the 5th day of post treatment, the uterine leiomyomas were observed with color Doppler ultrasound before and after the treatment , the treated tissues were stained with HE and observed under light and electron microscopes after operation. Results After 5 days of theatment by HIFU, we could see a strong comparison through color Doppler ultrasound that the internal echo in 23 cases of the uterine leiomyomas had increased after HIFU treatment , and the blood flow signal of both in and around had decreased or disapeared. The tissue of 23 specimens scanned with HI- FU showed stiff, grey and some tissue became dark purple alternated with grey. Light microscopic examina- tion showed degeneration and necrosis of tumor tissue in the treated region with distorted cells, shrinkage of nuclei, cell debris and karyolsis. The endothelial cells of blood vessel degenerated severely. Electron mi- croscopy showed in the specimens of treated tumor tissue, the cellular membrane was not totally ruptured, karyotheca disappeared, karyorrhexis, even karyolysis. The nuclei disappeared or karyotheea partly ruptured with vacuolation in endothidial ceils. Conclusions HIFU has a confirmed active killing effect on cells of human uterine leiomyoma and will become a new and non-invasive technique to treat uterine leiomyoma.