新疆地区265例子宫肌瘤和子宫腺肌瘤高强度聚焦超声临床治疗观察

The analysis of the validity of high intensive focused ultrasound in 265 patients on the treatment of the uterus myoma and adenomyosis in Xinjiang province

目的观察子宫肌瘤和子宫腺肌瘤高强度聚焦超声(HIFU)治疗效果及超声图像特征。方法对新疆地区来我院就诊临床诊断为子宫肌瘤和子宫腺肌瘤的265例患者行HIFU治疗,其中汉族206例,维吾尔族和其他民族59例。于治疗后1、3和6个月分别对患者进行随访及超声复查;疗效评价以治疗后患者子宫消融灶体积缩小或明显缩小、消融灶内血流减少或消失、月经量减少或月经正常、痛经、贫血等临床症状减轻或明显改善、无或轻微副反应发生为治疗显效和有效。结果 HIFU治疗后1、3和6个月,分别随访患者264例、244例、182例,治疗总有效率分别为53.4%(141/264)、75.0%(183/244)、64.3%(117/182),临床及超声复查显示,与治疗前比较,治疗后3个月疗效较显著,患者月经量明显减少[治疗前后分别为(140±30)mL和(70±40)mL],腹痛、贫血、痛经等临床症状明显改善;患者子宫消融灶明显缩小,治疗前后分别为(37.9±5.9)mm3和(18.9±1.3)mm3,治疗有效率为86.9%(212/244),子宫消融灶内血流减少;而治疗后6个月临床疗效与治疗后3个月相近。45例HIFU治疗中及治疗后发生副反应17.0%(45/265);65例(35.7%,65/182)治疗无效;93例患者治疗后失随访。结论在新疆地区采用HIFU技术对子宫肌瘤和子宫腺肌瘤患者进行微创消融治疗安全有效,副反应小,有利于疗效观察。

Objective To evaluate the validity of high intensity focused ultrasound （HIFU）used as a treatment of in uterus myoma and adenomyosis and analyze the ultrasonic features. Methods A total of 256 patients with uterus myoma and adenomyoma received HIFU treatment. Among them, there were 206 cases of Han races and 59 cases of Uygur or other races. All women were given following-up at 1, 3, 6 month after treatment. According to the status of clinical symptoms, the volume of tumor, the blood of the internal tumor and the improvement of side-effect, the effection of HIFU had been evaluated. Results The total efficiency among 264 patients is 53.4% （141/264） at 1 month after treatment, 75.0% （183/244） among 244 patients at 3 month after treatment, and 64.3 % （117/182） among 182 patients at 6 month after treatment. The patients had less menstrual blood after treatment 140 ± 30 mL before treatment; 70± 40 mL after treatment）, and other clinical symptoms, such as bellyache, anemia and dysmenorrhea all got great improvement. Also ultrasound showed that the uterine ablation lesions was significantly minished and the blood flow within the ablation lesions decreased after treatment. The curative effect is most visible at 3 months after treatment, with a similar effect at 6 months after treatment. Among all the patients receiving treatmet, 45 cases had side effects （17.0% ,45/265 ） , 65 cases （35.7% ,65/182） had no improvements, as well as 93 cases missed following-up. Conclusion HIFU treatment of uterus myoma and adenomyosis is feaible, safe and has fewer side effects than other treatment protocol.