超声消融治疗子宫肌瘤的近期并发症及其影响因素分析

Analysis of complications of high intensity focused ultrasound in treatment of uterine leiomyoma

目的 探讨超声消融治疗子宫肌瘤的近期常见并发症及其影响因素,为合理选择适应证、减少并发症提供理论依据.方法 回顾性分析超声消融治疗的子宫肌瘤患者171例（共231个肌瘤）的临床资料,分类总结治疗后近期的常见并发症,分析其影响因素.结果 超声消融治疗子宫肌瘤的常见并发症有：下腹疼痛71.9%（123/171）、阴道血性分泌物17.5%（30/171）、骶尾部和（或）臀部疼痛8.2%（14/171）、治疗区域皮肤水疱7.6%（13/171）、下肢疼痛4.7%（8/171）、血尿2.9%（5/171）、发热1.8%（3/171）等,无严重并发症发生.多重logistic回归多因素分析显示,下腹疼痛的影响因素有：肌瘤体积、治疗时间、平均功率（P〈0.05）;骶尾部和（或）臀部疼痛的影响因素有：肌瘤的位置[子宫后壁肌瘤治疗后,骶尾部和（或）臀部疼痛发生率高于肌瘤位于其他位置者,P〈0.05];阴道血性分泌物的影响因素有：治疗时间、肌瘤类型（黏膜下〉肌壁间〉浆膜下,P〈0.05）;治疗区域皮肤水疱的影响因素有：治疗时间（P〈0.05）;下肢疼痛、血尿、发热的各影响因素间比较,差异无统计学意义（P〉0.05）.结论 超声消融治疗子宫肌瘤最常见的并发症为下腹疼痛,治疗功率和治疗时间可能是影响并发症发生的重要因素.

Objective To analysis complications and its associated risk factors of high intensity focused ultrasound （HIFU） in treatment of uterine leiomyoma for selecting rationale indicated patients and reducing complications. Methods Medical documents of 171 patients with 231 leiomyomas in total treated by HIFU were studied retrospectively. Common complications were categorized and analyzed, the relationship between risk factors and complications were studied. Results Common complications in treatment of uterine leiomyomas by HIFU were 71.9% （123/171） of abdominal pain, 17.5% （30/171） of vaginal bloody discharge, 8.2% （14/171） of sacroiliac or buttock pain, 7. 6% （13/171） of skin blister,4. 7% （8/171） of leg pain, 2. 9% （5/171） of hematuria and 1.8% （3/171） of febrile. By logistic regression analysis, the factor correlated with abdominal pain included diameter of uterine leiomyomas,sonication time and average power （P 〈 0. 05）. The factor correlated with sacroiliac or buttock pain was uterine leiomyomas located in posteriors of uterine wall（P 〈0. 05）; the factors correlated with vaginal bloody discharge were sonication time and type of uterine leiomyomas （submucous 〉 intramural 〉 subserous, P 〈0. 05）; the factors correlated with skin blister was sonication time （P 〈 0. 05）. There were no statistical relationship between multiple factors and leg pain, hematuria, febrile （P 〉 0. 05）. Conclusion The modality of high-power and short-term treatment might reduce complications of HIFU ablation.