超声引导经皮子宫肌瘤微波消融后随访研究

The study of follow up of percutaneous microwave ablation for uterine fibroids treatment

目的 研究超声引导经皮穿刺子宫肌瘤微波消融治疗（PMAUF）后肌瘤的转归.方法 自2007年3月至2010年7月经解放军总医院第一附属医院明确诊断的40例症状性子宫肌瘤患者的40个肌瘤结节接受PMAUF.治疗后1 d用增强MRI检测肌瘤血供情况.1年内每隔3个月用超声检测肌瘤大小.每月随诊患者的月经情况,对有块状排出物者,收集标本送病理检查.结果 40个肌瘤结节中,22个肌壁间肌瘤,15个浆膜下肌瘤,3个黏膜下肌瘤.肌瘤均径3.7～9.0（6.4±1.5）cm.肌瘤体积14.6～341.1（140.1±87.4）cm^3.治疗后3个月肌瘤明显缩小,肌瘤内出现无回声区,6～7个月后无回声区逐渐消失,12个月时消融区回声仍较周围组织高.消融后1～8个月内,8例患者（黏膜下肌瘤2例,肌壁间肌瘤6例）月经期内有肉样组织排出,最大者长径约2.1 cm,排出物病理检查证实为坏死组织.浆膜下肌瘤患者均无坏死组织排出.有坏死组织排出者治疗后6～9个月肌瘤缩小率明显小于无坏死组织排出者（P＜0.01）.结论 PMAUF后黏膜下及肌壁间肌瘤坏死组织可随月经排出,浆膜下肌瘤或无坏死物排出的肌壁间肌瘤可发生部分液化并逐渐被吸收,这可能是肌瘤明显缩小或消失的主要原因.

Objective To study the prognosis of fibroid after ultrasound-guidance percutaneous microwave ablation （PMAUF）. Methods From Mar. 2007 to Jul. 2010 forty uterine fibroids in forty patients with symptoms which were diagnosed in our hospital accepted PMAUF. One day after treatment blood supply within the fibroid was evaluated, by enhanced MRI. The size of fibroid was measured by ultrasonograpy in one year with 3 months interval ,the monthly menstrual of patient was followed and the mass discharge through vagina were collected for pathological examination. Results Among the 40 fibroid nodules, 22 are intramural fibroids, 15 subserosal fibroids and 3 submucosal fibroids. The baseline mean diameter of the fibroids ranged from （3.7 to 9.0 ） cm, with an average of （ 6. 4 ± 1.5 ） cm. The mean volume ranged from （ 14.6 - 341.1 ） cm3, with an average of （ 140. 1 ± 87.4 ） cm^3. Three months after treatment, the anechoic zone was observed within the ablated nodules and disappeared in six to seven months. the echo of ablated zone keep higher than the surrounding tissue, whereas the size of fibroid shrank significantly. Meat tissue was discharged from vagina in 8 patients （2 cases of submucosal fibroids, 6 cases intramural fibroids） in the period of menstrual in 1 - 8 months after ablation. The largest dimension of the discharge was 2. 1 cm. Pathological examination confirmed the discharges as necrotic fibroid. The patients with subserosal fibroid had no discharge of necrotic tissue. The fibroid shrink rate was higher in the patients with vaginal discharges than that without vaginal discharges （ P 〈 0. 01 ）. Conclusions After PMAUF necrotic tissue of submucosal and intramural fibroids can be discharged through vagina, liquefaction in the center of subserosal and intramural fibroids may occur and be absorbed gradually, that may be the main reasons for fibroids reduced significantly or disappearance.